■大血管闭塞所致急性缺血性卒中(AIS-LVO)患者的护理标准包括在综合卒中中心(CSC)进行紧急机械血栓切除术(MT)的及时评估。在2019年冠状病毒大流行(COVID-19)开始期间,有关于急诊科(ED)操作中断和AIS-LVO患者管理延误的报告.在这项研究中,我们调查了从不同ED转移到学术CSC的重症监护复苏单元(CCRU)的患者的结果和手术,专门从事时间敏感疾病的快速转移。
■这是一项前瞻性回顾性研究,使用来自CSC卒中登记的前瞻性临床数据。从任何ED转移到CCRU并接受MT的成年患者符合条件。我们比较了2018年1月至2020年2月大流行前(PP)期间的时间间隔,例如ED进出和CCRU到达血管造影,2020年3月至2021年5月31日期间的大流行(DP)。我们使用分类和回归树(CART)分析来确定哪些时间间隔,除了临床因素,与良好的神经系统预后相关(90天改良Rankin量表0-2)。
■我们分析了203例患者:PP组135例(66.5%),DP组68例(33.5%)。从ED分诊到计算机断层扫描的时间(差7分钟,95%置信区间[CI]-12~-1,P<0.01)为DP组,但两组的ED进出相似。从CCRU到达血管造影的时间(差9分钟,DP组的95%CI4-13,P<0.01)较短。DP组中有49%的mRS≤2,PP组为32%(差异-17%,95%CI-0.32至-0.03,P<0.01)。CART确定了最初的国立卫生研究院卒中量表,年龄,ED进出时间,CCRU到达血管造影时间是预后良好的重要预测因素。
■总的来说,ED的护理过程和需要MT的患者的单一CSC没有受到大流行的严重影响,因为大流行期间的某些时间指标在统计学上短于大流行前的间隔.ED进出和CCRU到达血管造影等时间间隔是实现良好神经系统结局的重要因素。需要进一步研究以证实我们的观察并提高未来的运营效率。
UNASSIGNED: Standard of care for patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) includes prompt evaluation for urgent mechanical thrombectomy (MT) at a comprehensive stroke center (CSC). During the start of the coronavirus 2019 pandemic (COVID-19), there were reports about disruption to emergency department (ED) operations and delays in management of patients with AIS-LVO. In this study we investigate the outcome and operations for patients who were transferred from different EDs to an academic CSC\'s critical care resuscitation unit (CCRU), which specializes in expeditious transfer of time-sensitive disease.
UNASSIGNED: This was a pre-post retrospective study using prospectively collected clinical data from our CSC\'s stroke registry. Adult patients who were transferred from any ED to the CCRU and underwent MT were eligible. We compared time intervals in the pre-pandemic (PP) period between January 2018- February 2020, such as ED in-out and CCRU arrival-angiography, to those during the pandemic (DP) between March 2020-May 31, 2021. We used classification and regression tree (CART) analysis to identify which time intervals, besides clinical factors, were associated with good neurological outcome (90-day modified Rankin scale 0-2).
UNASSIGNED: We analyzed 203 patients: 135 (66.5%) in the PP group and 68 (33.5%) in the DP group. Time from ED triage to computed tomography (difference 7 minutes, 95% confidence interval [CI] -12 to -1, P < 0.01) for the DP group was statistically longer, but ED in-out was similar for both groups. Time from CCRU arrival to angiography (difference 9 minutes, 95% CI 4-13, P < 0.01) for the DP group was shorter. Forty-nine percent of the DP group achieved mRS ≤ 2 vs 32% for the PP group (difference -17%, 95% CI -0.32 to -0.03, P < 0.01). The CART identified initial National Institutes of Health Stroke Scale, age, ED in-and-out time, and CCRU arrival-to-angiography time as important predictors of good outcome.
UNASSIGNED: Overall, the care process in EDs and at this single CSC for patients requiring MT were not heavily affected by the pandemic, as certain time metrics during the pandemic were statistically shorter than pre-pandemic intervals. Time intervals such as ED in-and-out and CCRU arrival-to-angiography were important factors in achieving good neurologic outcomes. Further study is necessary to confirm our observation and improve operational efficiency in the future.