Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Ziv Medical Center, Safed, Israel.
Sci Rep. 2024 Nov 26;14(1):29291. doi: 10.1038/s41598-024-80872-7.
The indirect impact of the COVID-19 pandemic on clinical services in peripheral hospitals has not been fully described. We compared the impact of COVID-19 on Cerebral Vascular Accident (CVA) and ST-elevation myocardial infarction (STEMI) management and outcome in an Israeli peripheral hospital. We included 1029 CVA and 495 STEMI patients. Patients who arrived during (15/3/2020-15/4/2022) and before (1/1/2018-14/3/2020) the pandemic, were demographically comparable. During the pandemic, median time for CVA patients from arrival to imaging was longer (23 vs. 19 min, p = 0.001); timing from arrival to tissue Plasminogen Activator administration was similar (49 vs. 45 min, p = 0.61); transfer to another hospital was more common (20.3% vs. 14.4% p = 0.01) and median length of stay (LOS) was shorter (3 vs. 4 days, p < 0.05). Among STEMI patients, median time from arrival to intervention intra- pandemic was shorter (45 vs. 50 min p = 0.02); Mean LOS shorter (3.86 vs. 4.48 p = 0.01), and unplanned re-admission less frequent (7.8% vs. 14.6% p = 0.01). Mortality did not change significantly. Our data shows no major negative impact of the COVID-19 pandemic on CVA outcomes, and improved care for STEMI patients. Interviews with the neurology and cardiology staff are performed to investigate how quality of care was maintained during the crises.
COVID-19 大流行对周边医院临床服务的间接影响尚未得到充分描述。我们比较了 COVID-19 对以色列周边医院的脑卒中和 ST 段抬高型心肌梗死（STEMI）管理和结局的影响。共纳入 1029 例脑卒中患者和 495 例 STEMI 患者。到达时间处于（2020 年 3 月 15 日至 4 月 15 日）和大流行前（2018 年 1 月 1 日至 3 月 14 日）的患者在人口统计学方面具有可比性。在大流行期间，脑卒中患者从到达到成像的中位时间更长（23 分钟与 19 分钟，p=0.001）；从到达到组织型纤溶酶原激活物给药的时间相似（49 分钟与 45 分钟，p=0.61）；转院更常见（20.3%比 14.4%，p=0.01），住院时间更短（3 天与 4 天，p<0.05）。在 STEMI 患者中，大流行期间到达至介入治疗的中位时间更短（45 分钟与 50 分钟，p=0.02）；平均住院时间更短（3.86 天与 4.48 天，p=0.01），计划外再入院率更低（7.8%比 14.6%，p=0.01）。死亡率没有显著变化。我们的数据显示，COVID-19 大流行对脑卒中结局没有产生重大负面影响，并改善了 STEMI 患者的治疗。对神经科和心内科工作人员进行了访谈，以调查在危机期间如何维持护理质量。
