Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis
| Autor: | Sarah Rickard, Jane Molloy, Khalil Kawafi, Andy Vail, Srinath Meadipudi, Neil Holden, Ilse Burger, Craig J. Smith, Stephen Cross, Christopher Ashton, Matthew Gittins |
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| Rok vydání: | 2020 |
| Předmět: |
Time Factors
Interrupted Time Series Analysis 0302 clinical medicine Patient Admission Risk Factors Health care Pandemic Stroke Referral and Consultation education.field_of_study Delivery of Health Care Integrated Rehabilitation Hyperacute stroke England Ischemic Attack Transient Cardiology and Cardiovascular Medicine Coronavirus Infections medicine.medical_specialty Coronavirus disease 2019 (COVID-19) Population Pneumonia Viral Clinical Neurology Environment Article 03 medical and health sciences medicine Humans cardiovascular diseases education Pandemics business.industry Interrupted time-series TIA COVID-19 Emergency department Patient Acceptance of Health Care medicine.disease Stroke activity Emergency medicine Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Gittins, M, Ashton, C, Holden, N, Cross, S, Meadipudi, S, Kawafi, K, Burger, I, Rickard, S, Vail, A, Molloy, J & Smith, C 2020, ' Environmental factors and hyperacute stroke care activity during the COVID-19 pandemic: An interrupted time-series analysis ', Journal of Stroke & Cerebrovascular Diseases, vol. 29, no. 11, 105229 . https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105229 Journal of Stroke and Cerebrovascular Diseases |
| ISSN: | 1532-8511 |
| DOI: | 10.1016/j.jstrokecerebrovasdis.2020.105229 |
| Popis: | 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 (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd 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. |
| Databáze: | OpenAIRE |
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