Hbid Youssef, Stanley Kaili, Wolfe Charles D A, Bhalla Ajay, James Martin, Douiri Abdel
School of Life Course and Population Health Sciences, King's College London, Guy's Campus Great Maze Pond, London.
The Sentinel Stroke National Audit Programme, King's College London, Guy's Campus Great Maze Pond, London.
PLoS One. 2025 Sep 2;20(9):e0330903. doi: 10.1371/journal.pone.0330903. eCollection 2025.
The COVID-19 pandemic imposed significant pressures on healthcare services such as stroke care. This study aimed to assess the quality of stroke care and, outcome before, during and post lockdown.
Nationwide registry-based cohort study of patients with acute stroke admitted to hospitals in England, Wales, and Northern Ireland were analyzed. This included 114 hospitals for study cohorts of 261,451 in the pre-pandemic control period (01/04/2017-25/03/2020). The exposures studied include 16,843 during the first lockdown (26/03/2020-23/06/2020), 48,004 during the second lockdown (05/11/2020-17/05/2021), and 82,732 post-lockdowns (18/07/2021-30/06/2022). Logistic regression was used to compare odds of receiving aspects of acute stroke care across pandemic periods compared to the pre-pandemic period. Survival after stroke was assessed using restricted mean survival time (RMST) analysis, with models adjusted for age, sex, and stroke severity.
Admission to a stroke unit within 4-hours increased by 8% during the first lockdown but fell by 7% in the second lockdown and remained lower post-pandemic. During the first lockdown, brain imaging within 1-hour increased by 3%, but was not maintained thereafter. Stroke multidisciplinary access increased during the first lockdown but decreased in subsequent periods. Access to thrombectomy sequentially increased across time periods; by 40% during first lockdown (adjusted Odd-Ratio: 1.4; 95% CI:1.24-1.58), second lockdown (aOR: 1.77; 1.66-1.92), and 2-folds post-lockdown (aOR: 2.03; 1.92-2.15). Thrombolysis rates fell during the pandemic and did not recover post-pandemic. Although proportion of patients discharged with good recovery did not alter, 7-day mortality increased by 10% (hazard ratio: 1.10, 1.04-1.18) in the first lockdown period but improved thereafter.
This nationwide population data showed unprecedented levels of pressure from the COVID-19 pandemic which have had an enduring effect on the quality of hospital stroke care and patient outcomes. Stroke care has not fully recovered post-pandemic period suggesting limited resilience.
新冠疫情给中风护理等医疗服务带来了巨大压力。本研究旨在评估封锁前、封锁期间及封锁后的中风护理质量及预后情况。
对在英格兰、威尔士和北爱尔兰医院住院的急性中风患者进行全国性基于登记的队列研究。这包括在疫情前对照期（2017年4月1日至2020年3月25日）的261451名研究队列中的114家医院。研究的暴露情况包括第一次封锁期间（2020年3月26日至2020年6月23日）的16843例、第二次封锁期间（2020年11月5日至2021年5月17日）的48004例以及封锁后（2021年7月18日至2022年6月30日）的82732例。使用逻辑回归比较疫情期间与疫情前接受急性中风护理各方面的几率。使用受限平均生存时间（RMST）分析评估中风后的生存率，并对年龄、性别和中风严重程度进行模型调整。
在第一次封锁期间，4小时内入住中风单元的比例增加了8%，但在第二次封锁期间下降了7%，疫情后仍较低。在第一次封锁期间，1小时内进行脑部成像的比例增加了3%，但此后未保持上升趋势。中风多学科会诊在第一次封锁期间增加，但在随后时期减少。血管内血栓切除术的可及性随时间推移依次增加；在第一次封锁期间增加了40%（调整后的优势比：1.4；95%置信区间：1.24 - 1.58），第二次封锁期间（调整后的优势比：1.77；1.66 - 1.92）以及封锁后增加了两倍（调整后的优势比：2.03；1.92 - 2.15）。溶栓率在疫情期间下降，疫情后未恢复。尽管恢复良好出院的患者比例没有变化，但在第一次封锁期间7天死亡率增加了10%（风险比：1.10，1.04 - 1.18），但此后有所改善。
这项全国性人口数据显示了新冠疫情带来的前所未有的压力水平，对医院中风护理质量和患者预后产生了持久影响。疫情后中风护理尚未完全恢复，表明恢复能力有限。
