摘要
Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns. The objective was to assess the impact of changes in use of care and health reorganizations implementation, spurred by the first wave of the COVID- 19 pandemic on acute stroke management time. Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory and an ad-hoc collection of hospital reorganizations. The associations between reorganizations, use of care, and emergency unit (EU) admission-to-imaging time were analyzed through multivariate linear regression mixed models. Interaction terms between the use of care variables and the period (pre, per, post-wave) were introduced. Results: A total of 6,436 stroke patients were included in 14 hospitals. Four main trends were observed during the per-wave period compared to the pre and post-wave periods: 1) more frequent calls to Emergency Dispatch Organization (EDO) (65.5% vs 61.5% and 64.1%, p=0.083), 2) longer median times from symptoms onset- to-call to EDO (139 minutes vs. 121 minutes and 125 minutes, p=0.232), 3) longer median times from EU admission-to-imaging time (91 minutes vs. 83 minutes and 88 minutes, p=0.332), 4) less intravenous thrombolysis (14.6% vs. 19.4% and 16.7%, p=0.011). No association was found between reorganizations and EU admission-to-imaging times. Conclusions: Hospitals have demonstrated their adaptation ability during the first wave of the COVID-19 by implementing reorganizations without altering stroke pathway structuration. (Figure Presented).
摘要
Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns, particularly for vulnerable individuals, more likely impacted by health protection measures and modification of care support. The objective was to study the effect of the first Covid wave on the place of clinical (person at risk of severe COVID) and social vulnerabilities as health inequality on acute stroke management. Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory. The associations between vulnerabilities (clinical: age over 65 years old, cardiovascular history;socio-economic: deprivation index) and emergency unit admission-to-imaging time were analyzed through three multivariate linear regression mixed models. Interaction terms with time period (pre, per, post-wave) were introduced. Results: A total of 6,436 stroke patients were included in 14 hospitals. The models showed no statistically significant association between emergency unit admission-to-imaging time and advanced age (p=0.068), cardiovascular history (p=0.444) or deprivation (p=0.295), without any interaction with the COVID period. During the per (expb=1.169, 95%CI [1.006-1.359]) and post-wave (expb=1.072, 95%CI [0.984-1.168]) periods, the age-deleterious effect on stroke management time tended to decrease compared to the pre-wave period (expb=0.993, 95%CI [0.849- 1.162]). Conclusions: The COVID-19 pandemic induced no deep changes on the management time for the most vulnerable populations. An improvement time tendency is even noted for the elderly during the pre and post-wave periods.
摘要
Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.