Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown.
Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown.
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DOI：
10.1161/strokeaha.120.032176
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发表时间：
2021-05
期刊：
影响因子：
8.3
通讯作者：
TRISP Collaborators
中科院分区：
文献类型：
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作者：
Altersberger VL;Stolze LJ;Heldner MR;Henon H;Martinez-Majander N;Hametner C;Nordanstig A;Zini A;Nannoni S;Gonçalves B;Nolte CH;Baumgartner P;Kastrup A;Papanagiotou P;Kägi G;Leker RR;Zedde M;Padovani A;Pezzini A;Padjen V;Cereda CW;Ntaios G;Bonati LH;Rinkel LA;Fischer U;Scheitz JF;Wegener S;Turc G;Michel P;Gentile M;Rentzos A;Ringleb PA;Curtze S;Cordonnier C;Arnold M;Nederkoorn PJ;Engelter ST;Gensicke H;TRISP Collaborators
补充数字内容可在文本中找到。及时再灌注是治疗急性缺血性脑卒中患者的重要目标。然而，在2019冠状病毒病（COVID-19）大流行期间，院前和院内急救程序面临前所未有的挑战，这可能导致急性再灌注治疗的应用数量下降，并导致封锁期间该治疗的关键质量指标恶化。这项前瞻性多中心队列研究使用了接受再灌注治疗（即静脉溶栓或血管内治疗）的急性缺血性卒中患者的TRISP（缺血性卒中患者溶栓）登记数据。我们比较了2019年宣布封城后的前6周（封城期）和2019年同期（参照期）院前和院内基于时间的绩效指标（中风发病到入院、入院到治疗、入院到成像和成像到治疗时间）。次要结局包括24小时后卒中严重程度（美国国立卫生研究院卒中量表）和症状性颅内出血的发生（符合ECASS[欧洲-澳大拉西亚急性卒中研究]-II标准）。在20个卒中中心，540名患者在封锁期间接受静脉溶栓/血管内治疗，而在参考期间为578名患者（- 7% [95% CI, 5%-9%]）。在封锁期间，绩效指标没有显着变化（2020/2019分钟中位数：发病至入院133/145；入院治疗51/48）。在第一次影像可获得时间的患者中，入院到影像（20/19）和影像到治疗（31/30）的时间也是如此（n=871, 77.9%）。入院时（2020/2019:11/11）和24小时后（2020/2019:6/5）的美国国立卫生研究院卒中量表中位数以及症状性颅内出血的百分比（2020/2019:6.2/5.7）在两个时期之间无显著差异。COVID-19大流行封锁导致接受急性再灌注治疗的中风患者人数略有下降。更重要的是，2020年至2019年期间关键质量绩效指标的稳固稳定性可能表明，至少在成熟的欧洲中风中心，急性中风护理服务在封锁期间具有弹性。
Supplemental Digital Content is available in the text. Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.