Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis

Gittins, Matthew; Ashton, Christopher; Holden, Neil S.; Cross, Stephen; Meadipudi, Srinath; Kawafi, Khalil; Burger, Ilse; Rickard, Sarah; Vail, Andy; Molloy, Jane; Smith, Craig J.

doi:10.1016/j.jstrokecerebrovasdis.2020.105229

Cited by 9 publications

(14 citation statements)

References 22 publications

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“…The impacts on emergency department presentations and admissions to hospitals for acute stroke during the COVID-19 pandemic have been reported (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The steepest declines in presentations have been noted to immediately follow implementation of lockdown or stay at home orders (10)(11)(12). Several authors have reported a change in symptom severity of people presenting with stroke or transient ischemic attack (TIA).…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have reported a change in symptom severity of people presenting with stroke or transient ischemic attack (TIA). In some studies, presentations of minor strokes and TIAs have reduced by 31-45% (3,4,7,10,11,13). The impacts on patient arrival times to hospital (3,6,7,(12)(13)(14) and the delivery of stroke care that have been reported has differed between studies (4).…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

et al. 2021

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We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke clinicians were obtained from 53/72 (74%) hospitals participating in the AuSCR (80% nurses) via a voluntary, electronic feedback survey. Survey data were summarized to provide contextual information for the registry-based analysis. Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020. For the historical-control period, 9,308 episodes of care were compared with the pandemic period (8,992 episodes). Patient characteristics were similar for each cohort (median age: 75 years; 56% male; ischemic stroke 69%). Treatment in stroke units decreased progressively during the pandemic period (control: 76% pandemic: 70%, p < 0.001). Clinical staff reported fewer resources available for stroke including 10% reporting reduced stroke unit beds. Several time-based metrics were unchanged whereas door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012). Our data emphasize the need to maintain appropriate acute stroke care during times of national emergency such as pandemic management.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

et al. 2021

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“…Observing variables in fixed time intervals, like the daily numbers of COVID-19 incidences and related deaths in each country, naturally produces time series. In the ongoing research focussing on these time series, one can distinguish three main directions: First, the temporal dynamics of COVID-19 incidences and related deaths at the onset of the pandemic in a specific country [ 6 , 7 , 8 , 9 ]; second, the correlation between COVID-19 incidences and another factor of interest, ranging from air pollution [ 10 ] through social capital [ 11 ] to stroke admissions [ 12 ]; third, the effect of political measures—from social distancing to complete lockdown of public life—on COVID-19 incidence and related death numbers [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Nine Months of COVID-19 Pandemic in Europe: A Comparative Time Series Analysis of Cases and Fatalities in 35 Countries

Meintrup

Nowak-Machen

Borgmann

2021

IJERPH

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(1) Background: to describe the dynamic of the pandemic across 35 European countries over a period of 9 months. (2) Methods: a three-phase time series model was fitted for 35 European countries, predicting deaths based on SARS-CoV-2 incidences. Hierarchical clustering resulted in three clusters of countries. A multiple regression model was developed predicting thresholds for COVID-19 incidences, coupled to death numbers. (3) Results: The model showed strongly connected deaths and incidences during the waves in spring and fall. The corrected case-fatality rates ranged from 2% to 20.7% in the first wave, and from 0.5% to 4.2% in the second wave. If the incidences stay below a threshold, predicted by the regression model (R2=85.0%), COVID-19 related deaths and incidences were not necessarily coupled. The clusters represented different regions in Europe, and the corrected case-fatality rates in each cluster flipped from high to low or vice versa. Severely and less severely affected countries flipped between the first and second wave. (4) Conclusions: COVID-19 incidences and related deaths were uncoupled during the summer but coupled during two waves. Once a country-specific threshold of infections is reached, death numbers will start to rise, allowing health care systems and countries to prepare.

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“…11 Similar to our cohort, patients' attitudes were reported to contribute to the drop in numbers of patients attending for endoscopic procedures week on week at the height of the COVID-19 outbreak in Northern Italy. 12 Similar pattern of reduced hospital attendance during the pandemic was reported in stroke 13 and acute coronary syndrome likely leading to increased out-of-hospital deaths and long-term complications of myocardial infarction. 14 Using public transportation was a major concern among our patient group.…”

Section: Discussionmentioning

confidence: 65%

Impact of the COVID-19 Pandemic on Patients With Idiopathic Subglottic Stenosis

2020

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Objectives: To determine the number of patients with idiopathic subglottic stenosis (iSGS) who have contracted coronavirus disease 2019 (COVID-19), the impact of the pandemic on patients’ attitudes on seeking help and attending hospitals, as well as the delays in the offer of treatment from the local health care systems. Methods: A 29-question survey was distributed to an international mailing list of patients with subglottic stenosis to assess the patient experience during the COVID-19 pandemic. Results: A total of 543 patients with iSGS participated. Fewer than 1 in 10 patients with iSGS have experienced COVID-19 symptoms, which were predominantly mild to moderate, with only 2 hospitalizations. Most patients with iSGS (80.0%) have not been advised they are high risk for COVID-19, despite 36.5% of patients with iSGS being obese (body mass index of 30+). Delays to surgeries and in-office procedures have impacted 40.1% of patients currently receiving treatment, with 38.8% of patients increasingly struggling to breathe as a result. Anxiety and stress are increasing among patients, with 3 in 4 (75.2%) reporting they are anxious about travelling by public transport, contracting the virus in hospital and infecting loved ones (69.0% and 71.9%, respectively). Of greater concern is that 23.1% with increasing dyspnea state they are staying away from hospital despite their deteriorating health. Conclusions: The COVID-19 pandemic has had an impact on the physical and psychological health of patients with iSGS. Surgeons managing cases of laryngotracheal stenosis need to offer appropriate support and communication to these high risk patients. During the pandemic, this should include self-isolation if they are dyspneic or on treatments that may have reduced their immunity. In addition, they should offer safe clinical pathways to airway assessment and treatments, if they become necessary. To minimize unnecessary travel, much of the clinical monitoring can be carried out remotely, using telephone or video-based consultations, in conjunction with local health professionals.

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Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis

Cited by 9 publications

References 22 publications

COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry

Nine Months of COVID-19 Pandemic in Europe: A Comparative Time Series Analysis of Cases and Fatalities in 35 Countries

Impact of the COVID-19 Pandemic on Patients With Idiopathic Subglottic Stenosis

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