TY - JOUR
T1 - Environmental factors and hyperacute stroke care activity during the COVID- 19 pandemic: An interrupted time-series analysis
AU - Gittins, Matthew
AU - Ashton, Christopher
AU - Holden, Neil
AU - Cross, Stephen
AU - Meadipudi, Srinath
AU - Kawafi, Khalil
AU - Burger, Ilse
AU - Rickard, Sarah
AU - Vail, Andy
AU - Molloy, Jane
AU - Smith, Craig
PY - 2020/8/4
Y1 - 2020/8/4
N2 - Background and aims
Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors.
Methods
Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis
using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges.
Results
The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here.
Conclusion
Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID- 19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health
outcomes.
AB - Background and aims
Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors.
Methods
Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis
using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges.
Results
The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here.
Conclusion
Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID- 19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health
outcomes.
KW - COVID-19
KW - Interrupted time-series
KW - Stroke activity
KW - TIA
U2 - 10.1016/j.jstrokecerebrovasdis.2020.105229
DO - 10.1016/j.jstrokecerebrovasdis.2020.105229
M3 - Article
SN - 1052-3057
VL - 29
JO - Journal of Stroke & Cerebrovascular Diseases
JF - Journal of Stroke & Cerebrovascular Diseases
IS - 11
M1 - 105229
ER -