Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States of America.
PLoS One. 2023 Apr 26;18(4):e0284845. doi: 10.1371/journal.pone.0284845. eCollection 2023.
Patients with severe intracerebral hemorrhage (ICH) often suffer from impaired capacity and rely on surrogates for decision-making. Restrictions on visitors within healthcare facilities during the pandemic may have impacted care and disposition for patient with ICH. We investigated outcomes of ICH patients during the COVID-19 pandemic compared to a pre-pandemic period.
We conducted a retrospective review of ICH patients from two sources: (1) University of Rochester Get With the Guidelines database and (2) the California State Inpatient Database (SID). Patients were divided into 2019-2020 pre-pandemic and 2020 pandemic groups. We compared mortality, discharge, and comfort care/hospice. Using single-center data, we compared 30-day readmissions and follow-up functional status.
The single-center cohort included 230 patients (n = 122 pre-pandemic, n = 108 pandemic group), and the California SID included 17,534 patients (n = 10,537 pre-pandemic, n = 6,997 pandemic group). Inpatient mortality was no different before or during the pandemic in either cohort. Length of stay was unchanged. During the pandemic, more patients were discharged to hospice in the California SID (8.4% vs. 5.9%, p<0.001). Use of comfort care was similar before and during the pandemic in the single center data. Survivors in both datasets were more likely to be discharged home vs. facility during the pandemic. Thirty-day readmissions and follow-up functional status in the single-center cohort were similar between groups.
Using a large database, we identified more ICH patients discharged to hospice during the COVID-19 pandemic and, among survivors, more patients were discharged home rather than healthcare facility discharge during the pandemic.
患有严重脑出血 (ICH) 的患者通常认知能力受损，依赖代理人做出决策。大流行期间医疗保健设施对访客的限制可能会影响 ICH 患者的护理和处置。我们调查了 COVID-19 大流行期间与大流行前时期 ICH 患者的结局。
我们对两个来源的 ICH 患者进行了回顾性研究：（1）罗切斯特大学 Get With the Guidelines 数据库和（2）加利福尼亚州住院患者数据库 (SID)。患者分为 2019-2020 年大流行前和 2020 年大流行组。我们比较了死亡率、出院和舒适护理/临终关怀。使用单中心数据，我们比较了 30 天再入院和随访功能状态。
单中心队列包括 230 名患者（n = 122 名大流行前组，n = 108 名大流行组），加利福尼亚州 SID 包括 17534 名患者（n = 10537 名大流行前组，n = 6997 名大流行组）。在两个队列中，大流行前和大流行期间的住院死亡率没有差异。住院时间保持不变。在大流行期间，加利福尼亚州 SID 中有更多的患者被送往临终关怀（8.4%比 5.9%，p<0.001）。在单中心数据中，大流行前后使用舒适护理的情况相似。在两个数据集的幸存者中，大流行期间更有可能被送往家中而非医疗机构。单中心队列中的 30 天再入院率和随访功能状态在两组之间相似。
使用大型数据库，我们发现 COVID-19 大流行期间有更多的 ICH 患者被送往临终关怀，并且在幸存者中，大流行期间有更多的患者被送往家中而不是医疗机构。
