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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis
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Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis

机译：Covid-19大流行过程中的环境因素和超急性中风护理活动：中断时间序列分析

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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.
机译：背景和目的：2019冠状病毒疾病流行期间，急性卒中护理患者的准入和交付问题已经引起关注。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元（HASU）活动的关键人群水平事件，同时调整了环境因素。方法：急诊科2019冠状病毒疾病流行前（ED）和急诊卒中国家审计项目核心数据集（CVID-19流行期）（2020至2020年5月），收集三例HASUS每周卒中和出院次数。在对当地交通相关的空气污染和环境测量进行调整的同时，使用分段广义线性模型进行的中断时间序列分析调查了中风团队评估率、中风入院率、短暂性脑缺血发作（TIA）转诊率和中风出院率等关键人群水平事件。结果：英国2019冠状病毒疾病死亡前的三个HASU位点的ED卒中评估、入院、TIA转诊和出院的中位数为150, 114, 69，每周76次。2019冠状病毒疾病评估和卒中住院的稳定周趋势在第一英国医院COVID-19死亡（3月5日）和实施快速行动（4月6日）中减少约16%（21%的TIA），其中每周观察到适度增加4%和5%。TIA转诊增加了政府干预后（3月23日），但没有完全恢复到1月和2月观察到的数字。在本文报告的研究期间，卒中单元的出院趋势似乎未受影响。结论：2019冠状病毒疾病的发作，暂时性地改变了脑卒中的活动。人群中潜在的动机仍不清楚。这引发了人们的担忧，即患者可能已经避免了紧急医疗，从而导致短期和长期健康状况恶化。

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