Cadilhac Dominique A, Kim Joosup, Tod Emma K, Morrison Julie L, Breen Sibilah J, Jaques Katherine, Grimley Rohan, Jones Brett, Cloud Geoffrey C, Kleinig Timothy, Hillier Susan, Castley Helen, Lindley Richard I, Lannin Natasha A, Middleton Sandy, Yan Bernard, Hill Kelvin, Clissold Benjamin B, Mitchell Peter J, Anderson Craig S, Faux Steven G, Campbell Bruce C V
Stroke and Ageing Research School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
Front Neurol. 2021 Feb 26;12:621495. doi: 10.3389/fneur.2021.621495. eCollection 2021.
We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.
我们利用澳大利亚卒中临床注册系统（AuSCR）的数据，呈现了澳大利亚在新冠疫情第一波期间急性卒中护理的相关信息。澳大利亚首例新冠病例于2020年1月下旬记录在案，3月开始实施全国性的病毒防控限制措施。为了考虑卒中入院的季节性影响，将2020年1月至6月注册系统中的患者层面数据与2019年同期（历史对照）来自61家公立医院的数据进行了比较。我们使用描述性统计方法比较不同时期，并进行了中断时间序列分析。对参与AuSCR的53/72（74%）家医院（80%为护士）的卒中临床医生的看法进行了调查，这是一项自愿的电子反馈调查。对调查数据进行了汇总，以便为基于注册系统的分析提供背景信息。截至2020年6月底，注册系统的数据涵盖了澳大利亚91%新冠病例所在的地区。在历史对照期，9308例护理事件与疫情期（8992例）进行了比较。每个队列的患者特征相似（中位年龄：75岁；男性56%；缺血性卒中69%）。在疫情期间，卒中单元的治疗比例逐渐下降（对照：76%，疫情：70%，P<0.001）。临床工作人员报告称，用于卒中治疗的资源减少，包括10%的人报告卒中单元床位减少。一些基于时间的指标没有变化，而在疫情高峰期（2020年3月至4月）门到针时间更长（82分钟，对照：74分钟，P=0.012）。我们的数据强调了在国家紧急状态（如疫情管理）期间维持适当急性卒中护理的必要性。
