Clinical Pathway for Emergency Brain Surgery during COVID-19 Pandemic and Its Impact on Clinical Outcomes

Lee, Shin Heon; Jang, Ju-Sung; Chung, Jin-Won; Kwon, Jeong Taik; Park, Yong Sook

doi:10.3346/jkms.2021.36.e16

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…The quality of the 18 preselected articles was evaluated using the QATSDD tool. This process led to three being discarded (Lee et al, 2021; Rampe Reis et al, 2020; Silva et al, 2014), leaving 15 articles to be considered in the scoping review (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

Fernández

Fernández-Ordóñez

García‐Gámez

et al. 2022

Journal of Clinical Nursing

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Background: Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care. Design: We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA-ScR Checklist. Methods: Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011-2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained. Results: The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation. Conclusion: The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes.Relevance to clinical practice: The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.

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Section: Resultsmentioning

confidence: 99%

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

Fernández

Fernández-Ordóñez

García‐Gámez

et al. 2022

Journal of Clinical Nursing

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“…As a consequence, the time after CT scan to puncture that exclusively belonged to stroke centers was decreased. Lee et al ( 22 ) found that the time from patient arrival to surgery in the COVID-19 period was higher than that in the pre-COVID-19 period, but in the comparison of the subgroup of emergency surgery, the door-to-surgery time during the COVID-19 period was significantly shorter than that during the pre-COVID-19 period ( p = 0.04). However, our study showed that there was no significant difference in the numbers of emergency endovascular therapy between the two periods.…”

Section: Discussionmentioning

confidence: 96%

Impact of COVID-19 on Acute Stroke Presentation in a Designated COVID-19 Hospital

Tan

Liu

Fan³

et al. 2021

Front. Neurol.

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Objectives: Thousands of designated COVID-19 hospitals have been set up in China to fight the ongoing COVID-19 pandemic. Anecdotal reports indicate a falling rate of acute stroke diagnoses in these hospitals during the COVID-19 period. We conducted an exploratory single-center analysis to estimate the change in acute stroke presentation at the designated COVID-19 hospitals.Methods: This retrospective observational study included all patients admitted to Yongchuan Hospital Affiliated to Chongqing Medical University with acute stroke between January 24 and March 10, 2020. Patient demographics, characteristics of the stroke, treatment details, and clinical outcomes were compared with those of patients admitted in the corresponding period in the year before (2019, “the pre-COVID-19 period”). Subgroup analysis was performed in the ischemic and hemorrhagic stroke groups.Results: A total of 110 patients presented with acute stroke symptoms during the COVID-19 pandemic, compared with 173 patients in the pre-COVID-19 period. A higher proportion of stroke patients presented to the hospital via emergency medical services during the pandemic (48.2 vs. 31.8%, p = 0.006). There was a lower proportion of ischemic stroke patients (50.9 vs. 65.3%, p = 0.016) than in the preceding year. There were significantly fewer patients with 90-day modified Rankin Scale score ≥3 in the COVID-19 period compared with the pre-COVID-19 period (17.3 vs. 30.6%, p = 0.012). Among patients with ischemic stroke, the mean time from patient arrival to vessel puncture for emergency endovascular therapy in the COVID-19 period was shorter than that in the pre-COVID-19 period (109.18 ± 71.39 vs. 270.50 ± 161.51 min, p = 0.002). Among patients with hemorrhagic stroke, the rate of emergency surgical operation in the COVID-19 period was higher than that in the pre-COVID-19 period (48.1 vs. 30.0%, p = 0.047). The mean time from patient arrival to emergency surgical operation (15.31 ± 22.89 vs. 51.72 ± 40.47 min, p = 0.002) was shorter in the COVID-19 period than in the pre-COVID-19 period.Conclusions: Although fewer acute stroke patients sought medical care in this designated COVID-19 hospital during the COVID-19 pandemic, this type of hospital was more efficient for timely treatment of acute stroke. Recognizing how acute strokes presented in designated COVID-19 hospitals will contribute to appropriate adjustments in strategy for dealing with acute stroke during COVID-19 and future pandemics.

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“…There have been many discussions and reviews investigating the viability of 'elective' surgery as well as safe emergency surgery [22][23][24][25]. Most of the previous studies reported and emphasized the necessity for screening protocol, guidelines, or considerations before starting surgery, and a lack of experience reporting according to the structured guidelines was perceived [22][23][24][25][26]. Moreover, this hospital is designated as a COVID-19 specialized hospital by the Ministry of Health and Welfare in Korea; thus, sharing our experiences would be helpful to proceed with hospitalization and surgeries, including elective or emergency.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Efficacy of Universal Screening of Coronavirus Disease with Antigen-Detecting Rapid Diagnostic Tests at Point-or-Care Settings and Sharing the Experience of Admission Protocol—A Pilot Study

Park

Lee

et al. 2022

JPM

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Aims: To introduce the admission protocol of a COVID-19 specialized hospital outlined by the government, including the assessment of reverse transcription polymerase chain reaction (RT-PCR), low dose chest computed tomography (CT) and antigen-detecting rapid diagnostic test (Ag-RDT) for patient screening. Materials and Methods: This was a retrospective cohort study of 646 patients who were admitted between December 2020, and February 2021, during the third wave of COVID-19 in Korea. Ag-RDT and RT-PCR were routinely performed on all patients who required admission, and low-dose chest CT was performed on high-risk patients with associated symptoms. Any patients with high-risk COVID-19 infection according to the Ag-RDT test were quarantined alone in a negative pressured room, and those with low-risk COVID-19 infection remained in the preemptive quarantine room with or without negative pressure. The diagnostic values of the Ag-RDT test and associated cycle threshold (Ct) values of the RT-PCR test were subsequently evaluated. Results: In terms of the diagnostic value, the Ag-RDT for COVID-19 had a sensitivity of 68.3%, specificity of 99.5%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 97.9%. For the 355 symptomatic patients with low-dose chest CT, the diagnostic values of combined evaluations had a sensitivity of 90.2%, specificity of 99.0%, PPV of 86.1%, and NPV of 99.3%. The cut-off Ct value for positive Ag-RDT was ≤25.67 for the N gene (sensitivity: 89.3%, specificity: 100%), which was regarded as a high viable virus in cell culture. There were no patients or medical staff who had COVID-19 in the hospital. Conclusion: Appropriate patient care was possible by definitive triage of the area, according to the symptoms and using diagnostic tests. Screening protocols, including the Ag-RDT test and low-dose chest CT, could be helpful in emergency point-of-care settings.

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Clinical Pathway for Emergency Brain Surgery during COVID-19 Pandemic and Its Impact on Clinical Outcomes

Cited by 6 publications

References 16 publications

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

Impact of COVID-19 on Acute Stroke Presentation in a Designated COVID-19 Hospital

Analysis of the Efficacy of Universal Screening of Coronavirus Disease with Antigen-Detecting Rapid Diagnostic Tests at Point-or-Care Settings and Sharing the Experience of Admission Protocol—A Pilot Study

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