洛杉矶 9 家综合卒中中心急性缺血性卒中治疗受 COVID-19 影响情况
COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles.
机构信息
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA,
Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA.
出版信息
Cerebrovasc Dis. 2021;50(6):707-714. doi: 10.1159/000516908. Epub 2021 Jun 25.
OBJECTIVE
To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC).
METHODS
Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution.
RESULTS
There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ2 goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008).
CONCLUSION
LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.
目的
描述 COVID-19 对洛杉矶县（LAC）9 家综合卒中中心急性脑血管病治疗的影响。
方法
比较 2020 年 2 月 1 日至 4 月 30 日与 2019 年同期的急诊卒中代码激活量、患者特征、卒中严重程度、再灌注率、治疗时间和结局。每个参与机构均提供人口统计学数据。
结果
2020 年与 2019 年相比，LAC 的卒中代码激活量下降了 17.3%（分别为 1786 次和 2159 次，卡方拟合优度检验，p<0.0001），9 家参与的综合卒中中心。2020 年未接受任何再灌注治疗的患者减少了 16.6%（1527 人），而 2019 年为 1832 人。仅接受静脉溶栓治疗的患者减少了 31.8%（107 人）。仅接受机械血栓切除术（MT）的患者增加了 3%（102 人）。同时接受 IVT 和 MT 的患者减少了 31.8%（45 人）。2020 年的再灌注治疗时间与 2019 年相当。在 LAC 东部服务于更多拉丁裔人群的 CSC 在 2020 年接受 MT 的比例高于 2019 年。与 2019 年相比，2020 年的卒中严重程度略有增加（8.95 对 8.23，p=0.046）。2020 年出院回家的患者比例高于 2019 年（59.5%对 56.1%，p=0.034），出院到熟练护理机构的患者比例低于 2019 年（16.1%对 20.7%，p=0.0004），死亡患者比例高于 2019 年（8.6%对 6.3%，p=0.008）。
结论
与 2019 年相比，LAC 2020 年的总体卒中代码激活量下降。再灌注治疗时间与大流行前的指标相当。在 2020 年 COVID-19 大流行期间，LAC 的拉丁裔社区中，卒中严重程度的发生率和血栓切除术治疗的数量有所增加。与 2019 年同期相比，2020 年有更多的患者出院回家，更少的患者出院到熟练护理机构，更多的患者死亡。
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