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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323248

ABSTRACT

Objectives: To evaluate the impact of COVID-19’s lockdown on radiological examinations in Emergency Services. Methods: : Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5 to 8 and then 12 to 15).We included CT-scans or MRIs performed for strokes, multiple traumas (body-CT, BC), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. Results: : Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020.From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged.In 2020, examinations significantly decreased : suspected strokes decreased by 36% (1052 vs 675, p <0.001), BC by 62% (349 vs 134, p <0.001), CTr by 52% (1853 vs 895, p <0.001) and for ANTAP, appendicitis decreased by 38% (145 vs 90, NS) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS).The number of exams per centre decreased by 13% (185.5 vs. 162.5, p <0.001) whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p <0.001). Conclusion: Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319182

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods: We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results: A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period (55 (54.5%) vs 74 (69.2%);p=0.03) and was mainly due to time delay among patients treated with MT. The volume of MT remains stable over the two periods (72 (71.3%) vs 65 (60.8%);p=0.14) but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260];p<0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410];p<0.01). Conclusions: Our study showed a decrease of the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-309682

ABSTRACT

Background: To describe the clinical characteristics, management, and outcome of patients admitted in French emergency departments (EDs) for COVID-19 suspicion. Methods: A prospective, multicenter, observational study was conducted in 4 EDs. Adult patients (≥18 years) admitted in EDs between March 6, 2020 and May 10, 2020, hospitalized, and who were presenting symptoms evocative of COVID-19 were included. The clinical features, management, and prognosis of patients was compared according to their confirmed COVID-19 status. Results: A total of 2,686 patients were included, among them 760 (28.3%) were COVID-19 positive. Among the latter, the mean ± SD age was 71.5 ± 16.5 years. A total of 364 (48.0%) positive patients had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese, and 114 (15.0%) had chronic respiratory disease. The proportion of patients admitted in intensive care units (ICU) was higher among COVID-19 positive patients (185, 24.3%) compared to COVID-19 negative patients (206, 10.7%;p<0.001) and they required mechanical ventilation more frequently (89, 11.9% vs 37, 1.9%;p<0.001). The median [IQR] length of hospital stay was longer among COVID-19-positive patients (10 [6-15] vs 6 [2-11] days;p<0.001). The in-hospital mortality was significantly higher among COVID-19 positive patients (139, 18.3% vs 149, 7.7%;p<0.001). Conclusions: This study suggests that among the COVID-19 suspected patients admitted in EDs and requiring a hospitalization, the management was different according to the confirmed COVID-19 status and required different resources in terms of ICU beds and ventilator support.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308880

ABSTRACT

COVID-19 pandemic highlighted the need for real-time monitoring of diseases evolution to rapidly adapt restrictive measures.Objective: To investigate radiological markers of COVID-19–related emergency activity as global estimators of pandemic evolution in France.Methods: This prospective multicentric study incorporated two sources of data from March to November 2020: an open-source epidemiological dataset, collecting daily hospitalizations, intensive care unit admissions, hospital deaths and discharges, and a teleradiology dataset corresponding to the weekly number of CT-scans performed in 65 emergency centres and interpreted remotely. CT-scans specifically requested for COVID-19 suspicion, diagnosis or aggravation were monitored. Teleradiological and epidemiological time series were aligned. Their relationships were estimated through a cross-correlation function, and their extremes and breakpoints compared. Dynamic linear models were trained to forecast the weekly hospitalizations in France based on teleradiological activity predictors.Results: Overall, 100,018 CT-scans were included over 36 weeks, and 19,133 (19%) performed within the COVID-19 workflow. Concomitantly, 227,677 hospitalizations were reported. Teleradiological and epidemiological time series were almost perfectly superimposed (cross-correlation coefficients at lag 0: 0.90–0.92). Maximal number of COVID-19 CT-scans was reached the week of 2020-03-23 (1,086 CT-scans), one week before the highest hospitalizations (23,542 patients). The best valid forecasting model combined the number of COVID-19 CT-scans and the number of hospitalizations during the prior two weeks and provided the lowest mean absolute percentage (5.09%, testing period: 2020-11-02 to 2020-11-29).Conclusion: Monitoring COVID-19 CT-scan activity in emergencies accurately and instantly predicts hospitalizations and help adjust medical resources, paving the way for complementary public health indicators.Funding Statement: This work received no funding.Declaration of Interests: Authors declare no relevant relationships except for Drs V. Thomson and G. Gorincour who have shares in DeepLink Medical, supplier of teleradiology software.Ethics Approval Statement: This prospective multicentric observational study was approved by the French radiological ethics review board (N° CRM-2012-120).

5.
Insights Imaging ; 12(1): 103, 2021 Jul 22.
Article in English | MEDLINE | ID: covidwho-1320536

ABSTRACT

BACKGROUND: COVID-19 pandemic highlighted the need for real-time monitoring of diseases evolution to rapidly adapt restrictive measures. This prospective multicentric study aimed at investigating radiological markers of COVID-19-related emergency activity as global estimators of pandemic evolution in France. We incorporated two sources of data from March to November 2020: an open-source epidemiological dataset, collecting daily hospitalisations, intensive care unit admissions, hospital deaths and discharges, and a teleradiology dataset corresponding to the weekly number of CT-scans performed in 65 emergency centres and interpreted remotely. CT-scans specifically requested for COVID-19 suspicion were monitored. Teleradiological and epidemiological time series were aligned. Their relationships were estimated through a cross-correlation function, and their extremes and breakpoints were compared. Dynamic linear models were trained to forecast the weekly hospitalisations based on teleradiological activity predictors. RESULTS: A total of 100,018 CT-scans were included over 36 weeks, and 19,133 (19%) performed within the COVID-19 workflow. Concomitantly, 227,677 hospitalisations were reported. Teleradiological and epidemiological time series were almost perfectly superimposed (cross-correlation coefficients at lag 0: 0.90-0.92). Maximal number of COVID-19 CT-scans was reached the week of 2020-03-23 (1 086 CT-scans), 1 week before the highest hospitalisations (23,542 patients). The best valid forecasting model combined the number of COVID-19 CT-scans and the number of hospitalisations during the prior two weeks and provided the lowest mean absolute percentage (5.09%, testing period: 2020-11-02 to 2020-11-29). CONCLUSION: Monitoring COVID-19 CT-scan activity in emergencies accurately and instantly predicts hospitalisations and helps adjust medical resources, paving the way for complementary public health indicators.

6.
Soins ; 66(856): 20-24, 2021 Jun.
Article in French | MEDLINE | ID: covidwho-1287233

ABSTRACT

The Eemergency plans for outside hospitals (ORSEC) and inside hospitals (white plan) are often linked and must be well structured in order to respond to the tensions created by exceptional health situations. They must be designed, used and updated like toolboxes. How is the chain of care organised? What is the role of the samu (emergency medical assistance service) in the preparation, activation and coordination of the white plan?


Subject(s)
Emergency Medical Services , France , Humans , Organizations
7.
Insights Imaging ; 12(1): 30, 2021 Mar 03.
Article in English | MEDLINE | ID: covidwho-1116829

ABSTRACT

OBJECTIVES: To evaluate the impact of COVID-19's lockdown on radiological examinations in emergency services. METHODS: Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5-8 and then 12-15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. RESULTS: Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre's number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p < 0.001), Body-CT by 62% (349 vs 134, p < 0.001), CTr by 52% (1853 vs 895, p < 0.001) and for ANTAP, appendicitis decreased by 38% (45 vs 90, not statistically significant (NS)) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS). The number of examinations per centre decreased by 13% (185.5 vs 162.5, p < 0.001), whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p < 0.001). CONCLUSION: Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.

8.
J Neurol ; 268(7): 2314-2319, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-754555

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. METHODS: We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. RESULTS: A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410]; p < 0.01). CONCLUSIONS: Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.


Subject(s)
Brain Ischemia , COVID-19 , Stroke , Thrombectomy , Thrombolytic Therapy , Brain Ischemia/complications , Brain Ischemia/epidemiology , Brain Ischemia/therapy , France , Humans , Pandemics , Prospective Studies , Reperfusion , Retrospective Studies , Stroke/epidemiology , Stroke/therapy , Treatment Outcome
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