RESUMEN
BACKGROUND: The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. METHODS: Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. RESULTS: Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. CONCLUSION: The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.
Asunto(s)
COVID-19 , Hospitales de Enseñanza/estadística & datos numéricos , Neuroimagen/estadística & datos numéricos , Pandemias , Chicago , Urgencias Médicas , Servicios Médicos de Urgencia/estadística & datos numéricos , Humanos , Pacientes Internos , Imagen por Resonancia Magnética , Pacientes Ambulatorios , Cintigrafía , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones por Coronavirus/epidemiología , Neuroimagen/estadística & datos numéricos , Neumonía Viral/epidemiología , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Betacoronavirus , COVID-19 , Bases de Datos Factuales , Humanos , Neuroimagen/tendencias , Pandemias , SARS-CoV-2 , Estados UnidosAsunto(s)
Betacoronavirus , Infecciones por Coronavirus , Neuroimagen/métodos , Servicio de Medicina Nuclear en Hospital/organización & administración , Pandemias , Neumonía Viral , Encéfalo/diagnóstico por imagen , Encéfalo/virología , COVID-19 , Ensayos Clínicos como Asunto , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/epidemiología , Atención a la Salud , Demencia/terapia , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/virología , Neuroimagen/estadística & datos numéricos , Estudios Observacionales como Asunto , Trastornos del Olfato/etiología , Trastornos del Olfato/virología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Tomografía de Emisión de Positrones , Cuarentena , SARS-CoV-2 , Trombofilia/etiología , Trombofilia/virología , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
BACKGROUND AND PURPOSE: The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. METHODS: On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. RESULTS: At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. CONCLUSIONS: The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.