Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic.
Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic.
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DOI：
10.1161/strokeaha.120.031300
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发表时间：
2021-04
期刊：
影响因子：
8.3
通讯作者：
Schwamm LH
中科院分区：
文献类型：
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作者：
Etherton MR;Zachrison KS;Yan Z;Sveikata L;Bretzner M;Estrada J;Viswanathan A;Singhal AB;Schwamm LH
在COVID-19大流行期间，患者的求诊情况可能发生了变化。在中风中，延迟或避免治疗可能导致严重的发病率。我们试图确定大流行对卒中患者表现模式和护理质量的影响。我们分析了来自25家新英格兰医院的数据：一家城市学术综合卒中中心（CSC）和远程卒中中心，以及远程卒中网络中的24家spoke医院。我们纳入了2019年11月1日至20220年4月30日期间，来自24个辐条的所有远程中风咨询，以及CSC中心的所有中风入院。我们比较了2020年3月1日前后的就诊率、就诊及时性和护理质量。我们在符合条件的受试者中检查了患者人口统计学、卒中严重程度、及时性、诊断（包括大血管闭塞（LVO））、阿替普酶使用和血管内血栓切除术的趋势。我们比较了比例和双变量比较来检查2020年3月1日之前和之后的变化，并使用线性回归来检查随时间的趋势。在1248例患者报告中（844例远程卒中咨询，404例CSC入院），远程卒中咨询和缺血性卒中患者入院在辐条和枢纽中下降。年龄和中风严重程度在研究期间没有变化。我们发现在中风医院阿替普酶的使用没有变化，但我们的CSC确实注意到阿替普酶的使用和血栓切除术的减少。患者就诊和护理提供的时间指标没有变化，然而，在大流行期间，吞咽困难筛查、早期抗血栓启动和早期静脉血栓栓塞预防的质量指标的依从率有所降低。在本区域分析中，我们发现在2019冠状病毒病大流行期间，远程卒中咨询和缺血性卒中入院人数减少，卒中护理措施质量的表现也有所下降。与先前的报道相反，我们没有发现如果症状较轻的患者避免住院治疗，可能会增加取栓量或降低临床严重程度。
Patient care-seeking has likely changed during the COVID-19 pandemic. In stroke, delayed or avoided care may translate to substantial morbidity. We sought to determine the effect of the pandemic on patterns of stroke patient presentation and quality of care. We analyzed data from 25 New England hospitals: one urban, academic comprehensive stroke center (CSC) and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes, and all stroke admissions to the CSC hub from 11/1/2019 through 4/30/20220. We compared rates of presentation, timeliness presentation, and quality of care pre- vs. post-3/1/2020. We examined trends in patient demographics, stroke severity, timeliness, diagnoses including large vessel occlusion (LVO), alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- vs. post-3/1/2020, and used linear regression to examine trends over time. Among 1248 patient presentations (844 telestroke consultations, 404 CSC admissions), telestroke consultations and ischemic stroke patient admissions decreased among the spokes and hub. Age and stroke severity were unchanged over the study period. We found no change in alteplase administration at telestroke spoke hospitals, but did note a decrease in both alteplase use and thrombectomy at our CSC. Time metrics for patient presentation and care delivery were unchanged, however, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic. In this regional analysis, we found decreasing telestroke consultations and ischemic stroke admissions, and reduced performance on stroke quality of care measures during the COVID-19 pandemic. Contrary to prior reports, we did not find an increase in thrombectomy nor decrease in clinical severity that might be expected if patients with milder symptoms avoided hospitalization.