Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK.
Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK.
J Neurol. 2022 Apr;269(4):1741-1750. doi: 10.1007/s00415-021-10819-9. Epub 2021 Oct 15.
The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke.
This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March-16th May 2018 (pre-COVID-19 pandemic); and 16th March-16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System-29 (PROMIS-29 version 2.0) at 30 days after stroke.
We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001).
Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.
COVID-19 大流行及相关的社会隔离措施可能对社区医疗服务提供以及在医院治疗后的急性疾病（包括卒中）的结局产生不利影响。我们旨在评估 COVID-19 大流行对急性卒中住院患者报告的健康结局的影响。
这项回顾性研究纳入了入住英国大学学院医院 NHS 基金会信托基金超急性卒中病房的急性卒中成年患者。我们纳入了同一地理人群在两个时间点的两个连续入组患者队列：2018 年 3 月 16 日至 5 月 16 日（COVID-19 大流行前）；以及 2020 年 3 月 16 日至 5 月 16 日（COVID-19 大流行期间）。两个队列的患者均在卒中后 30 天完成了验证后的患者报告结局测量信息系统-29（PROMIS-29 版本 2.0）。
我们纳入了 205 例在 30 天存活的患者（COVID-19 大流行前入院 106 例，COVID-19 大流行期间入院 99 例），其中 201/205（98%）提供了患者报告的健康结局。在校正混杂因素后，COVID-19 大流行期间因急性卒中入院与焦虑增加（β=28.0，p<0.001）、疲劳（β=9.3，p<0.001）、抑郁（β=4.5，p=0.002）、睡眠障碍（β=2.3，p=0.018）、疼痛干扰（β=10.8，p<0.001）；以及身体功能（β=5.2，p<0.001）和社会角色及活动参与（β=6.9，p<0.001）减少独立相关。
与大流行前队列相比，COVID-19 大流行第一波期间因急性卒中入院的患者在 30 天随访时在所有领域的健康结局均较差。未来任何大流行的卒中服务规划均应包括减轻对患者健康的这种重大不利影响的措施。
