Rose David Z, Zhou Lili, Johnson Karlon H, Schutt Charles, de Jesus Daniel M Reyes, Gardener Hannah, Gutierrez Carolina M, Foster Dianne, Jameson Angus, Koch Sebastian, Ying Hao, Alkhachroum Ayham, Romano Jose G, Rundek Tatjana, Asdaghi Negar
University of South Florida Morsani College of Medicine, Tampa, FL USA.
University of Miami Miller School of Medicine, Miami, FL USA.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108179. doi: 10.1016/j.jstrokecerebrovasdis.2024.108179. Epub 2024 Dec 6.
Resource allocation for stroke care was impacted worldwide by the Coronavirus 2019 (COVID19) pandemic. Regionally, worsened stroke outcomes varied, however comparative year-over-year in-hospital performance metrics from the pandemic are unreported. Therefore, within the large Florida Stroke Registry (FSR), we assessed the pandemic's effects upon the American Heart Association (AHA) Get With The Guidelines (GWTG) ischemic stroke metrics and the meta-metric, Defect-Free Care (DFC).
From March 2017 to February 2021, FSR collected 146,593 patients with a diagnosis of ischemic stroke or TIA (31,940 between 2017-2018; 35,086 between 2018-2019; 39,722 between 2019-2020; 39,845 between 2020-2021). FSR evaluated DFC, intravenous thrombolytic (IVT) use, endovascular therapy (EVT) use, and Door-To-Needle (DTN), Door-To-Computed Tomography (DTCT), and Door-To-Puncture (DTP) times.
Pre-pandemic versus pandemic stroke patients' demographics were similar (49.0 % vs. 48.6 % female, age 70.7±14.3 vs. 70.5±14.1 years, 64.0 % vs. 65.3 % white, 18.6 % vs. 18.8 % black, 17.4 % vs. 16.0 % Hispanic). Pandemic strokes, versus the immediate year pre-pandemic, were significantly more severe (median NIHSS 4 [IQR 8] vs. 3 [7]), utilized emergency medical services more (59.2 % vs. 57.6 %) and were more likely to receive EVT (8.0 % vs. 7.0 %). IVT use, and DTCT and DTP times were unchanged. The meta-metric DFC improved year-over-year, albeit slower during the pandemic [2017/18-2018/19: 70.7 % to 74.9 % (+4.2 %); 2018/19-2019/20: 74.9 % to 82.1 % (+7.2 %); 2019/20-2020/21: 82.1 % to 85.2 % (+3.1 %)].
Despite pandemic challenges, the stroke meta-metric DFC improved, albeit more slowly than pre-pandemic years. In this large statewide registry, pandemic patients received EVT more, potentially due to more severe stroke presentations. Stroke care infrastructure preparedness for future pandemics is warranted.
2019年冠状病毒病（COVID-19）大流行对全球范围内的中风护理资源分配产生了影响。在不同地区，中风结局恶化情况各不相同，然而，关于该大流行期间逐年比较的住院绩效指标尚无报告。因此，在大型的佛罗里达中风登记处（FSR）中，我们评估了该大流行对美国心脏协会（AHA）的“遵循指南”（GWTG）缺血性中风指标以及综合指标“无缺陷护理”（DFC）的影响。
2017年3月至2021年2月，FSR收集了146,593例诊断为缺血性中风或短暂性脑缺血发作（TIA）的患者（2017 - 2018年期间为31,940例；2018 - 2019年期间为35,086例；2019 - 2020年期间为39,722例；2020 - 2021年期间为39,845例）。FSR评估了DFC、静脉溶栓（IVT）的使用、血管内治疗（EVT）的使用以及门到针（DTN）、门到计算机断层扫描（DTCT）和门到穿刺（DTP）时间。
大流行前与大流行期间中风患者的人口统计学特征相似（女性比例分别为49.0%对48.6%，年龄分别为70.7±14.3岁对70.5±14.1岁，白人比例分别为64.0%对65.3%，黑人比例分别为18.6%对18.8%，西班牙裔比例分别为17.4%对16.0%）。与大流行前紧挨着的那一年相比，大流行期间的中风病情明显更严重（美国国立卫生研究院卒中量表[NIHSS]中位数为4[四分位间距8]对3[7]），更多地使用了紧急医疗服务（59.2%对57.6%），并且更有可能接受EVT（8.0%对7.0%）。IVT的使用以及DTCT和DTP时间没有变化。综合指标DFC逐年有所改善，尽管在大流行期间改善速度较慢[2017/18 - 2018/19：从70.7%升至74.9%（+4.2%）；2018/19 - 2019/20：从74.9%升至82.1%（+7.2%）；2019/20 - 2020/21：从82.1%升至85.2%（+3.1%）]。
尽管面临大流行带来的挑战，但中风综合指标DFC仍有所改善，不过改善速度比大流行前几年更慢。在这个全州范围的大型登记处中，大流行期间的患者接受EVT的比例更高，这可能是由于中风表现更为严重。有必要为未来的大流行做好中风护理基础设施的准备。
