Background and aims

Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors.

Methods

Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges.

Results

The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5^th March) and the implementation of the Act-FAST campaign (6^th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23^rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here.

Conclusion

Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID-19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health outcomes.

中文翻译：

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COVID-19 大流行期间的环境因素和超急性中风护理活动：中断时间序列分析。

背景和目标

在 COVID-19 大流行期间，人们对患者获得和提供急性中风护理的担忧引起了关注。我们调查了大曼彻斯特和东柴郡 (GM & EC) 内三个超急性卒中单位 (HASU) 活动的关键人口水平事件，同时调整了环境因素。

方法

三个 HASU 的每周中风入院和出院计数是在 COVID-19 大流行之前和期间（2020 年 1 月至 2020 年 5 月）从急诊室 (ED) 数据和前哨中风国家审计计划核心数据集收集的。在调整当地交通相关的空气污染和环境测量的同时，使用分段广义线性模型进行中断时间序列分析，调查了中风团队急诊评估、中风入院、短暂性脑缺血发作（TIA）转诊率的关键人群水平事件），和中风放电。

结果

在英国首例 COVID-19 死亡之前，三个 HASU 站点的 ED 中风评估、入院、TIA 转诊和出院总数中位数分别为每周 150 例、114 例、69 例和 76 例。^{从第一例英国医院 COVID-19 死亡（ 3}月 5 日）到实施 Act-FAST 运动（4 月 6 日）^，急诊室评估和中风入院率每周稳定趋势下降约 16%（TIA 下降 21%），其中据观察，每周略有 4% 和 5% 的增长。政府干预（3 月 23 日^）后，TIA 转诊量有所增加，但没有完全恢复到 1 月和 2 月观察到的数字。在此报告的研究期间，卒中单位的出院趋势似乎未受影响。

结论

尽管对环境因素进行了调整，但中风活动仍因 COVID-19 大流行而暂时改变。人们的潜在动机仍不清楚。这引起了人们的担忧，即患者可能避免了紧急医疗护理，从而冒着短期和长期健康结果较差的风险。