Emergency Department, Hospital Clínico San Carlos, IDISSC, Univesidad Complutense, Madrid, Spain.
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain.
Acad Emerg Med. 2021 Nov;28(11):1236-1250. doi: 10.1111/acem.14389. Epub 2021 Sep 29.
We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization.
We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.
We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).
The incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.
我们调查了在住院前在急诊科（ED）就诊的 COVID-19 患者中发生的卒中发生率、预测变量、临床特征和卒中结局。
我们回顾性分析了在西班牙 62 家急诊科 COVID-19 大流行期间确诊为卒中的所有 COVID-19 患者。我们形成了两个对照组：没有卒中的 COVID-19 患者（对照组 A）和没有 COVID-19 的卒中患者（对照组 B）。我们比较了病例和对照组之间的疾病特征和四个结局。
我们在 ED 中发现了 147 例 COVID-19 患者的卒中（1.96‰，95%置信区间[CI] = 1.66‰至 2.31‰），低于非 COVID-19 患者（6,541/1,388,879，4.71‰，95%CI = 4.60‰至 4.83‰；比值比[OR] = 0.42，95%CI = 0.35 至 0.49）。估计每年每 100,000 名个体的卒中标准化发病率分别为 COVID-19 和非 COVID-19 个体的 124 和 133（COVID 患者的 OR = 0.93，95%CI = 0.87 至 0.99）。与 COVID-19 患者发生卒中风险增加相关的基线特征包括高血压、糖尿病、先前的脑血管和冠状动脉疾病。临床症状上，这些患者更常出现意识混乱、意识减退和晕厥，以及更高的 D-二聚体浓度和白细胞计数。在校正年龄和性别后，与 COVID-19 无卒中对照组相比，病例组的住院和重症监护病房（ICU）入院率更高（但死亡率没有差异）（OR = 3.41，95%CI = 1.27 至 9.16；和 OR = 3.79，95%CI = 1.69 至 8.50），并且与非 COVID-19 卒中对照组相比，住院时间更长，院内死亡率更高（OR = 1.55，95%CI = 1.24 至 1.94；和 OR = 1.77，95%CI = 1.37 至 2.30）。
在 ED 就诊的 COVID-19 患者中卒中的发生率低于非 COVID-19 参考样本。与无卒中的 COVID-19 患者相比，有卒中的 COVID-19 患者更需要住院和 ICU 入院，住院时间更长，院内死亡率更高。
