ArticlePloS one2025
Stroke care in the United Kingdom before, during, and after the COVID-19 lockdowns: A retrospective nationwide cohort study.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimThe 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.
methodsNationwide 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.
resultsAdmission 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.
conclusionThis 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.
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