Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic.
Identifieur interne : 000961 ( Main/Exploration ); précédent : 000960; suivant : 000962Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic.
Auteurs : Mai N. Nguyen-Huynh ; Xian Nan Tang ; David R. Vinson ; Alexander C. Flint ; Janet G. Alexander ; Melissa Meighan ; Molly Burnett ; Stephen Sidney ; Jeffrey G. KlingmanSource :
- Stroke [ 1524-4628 ] ; 2020.
Descripteurs français
- KwdFr :
- Acceptation des soins par les patients (MeSH), Accident vasculaire cérébral (thérapie), Accident vasculaire cérébral (épidémiologie), Adulte (MeSH), Adulte d'âge moyen (MeSH), Ambulances (MeSH), Betacoronavirus (MeSH), Californie (épidémiologie), Comorbidité (MeSH), Durée du séjour (statistiques et données numériques), Femelle (MeSH), Fibrillation auriculaire (épidémiologie), Humains (MeSH), Hôpitaux communautaires (MeSH), Indice de gravité de la maladie (MeSH), Infarctus du myocarde (épidémiologie), Infections à coronavirus (MeSH), Mortalité hospitalière (MeSH), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (MeSH), Résultat thérapeutique (MeSH), Sortie du patient (MeSH), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Télémédecine (MeSH), Études de cohortes (MeSH).
- MESH :
- statistiques et données numériques : Durée du séjour.
- thérapie : Accident vasculaire cérébral.
- épidémiologie : Accident vasculaire cérébral, Californie, Fibrillation auriculaire, Infarctus du myocarde.
- Acceptation des soins par les patients, Adulte, Adulte d'âge moyen, Ambulances, Betacoronavirus, Comorbidité, Femelle, Humains, Hôpitaux communautaires, Indice de gravité de la maladie, Infections à coronavirus, Mortalité hospitalière, Mâle, Pandémies, Pneumopathie virale, Résultat thérapeutique, Sortie du patient, Sujet âgé, Sujet âgé de 80 ans ou plus, Télémédecine, Études de cohortes.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Ambulances (MeSH), Atrial Fibrillation (epidemiology), Betacoronavirus (MeSH), California (epidemiology), Cohort Studies (MeSH), Comorbidity (MeSH), Coronavirus Infections (MeSH), Female (MeSH), Hospital Mortality (MeSH), Hospitals, Community (MeSH), Humans (MeSH), Length of Stay (statistics & numerical data), Male (MeSH), Middle Aged (MeSH), Myocardial Infarction (epidemiology), Pandemics (MeSH), Patient Acceptance of Health Care (MeSH), Patient Discharge (MeSH), Pneumonia, Viral (MeSH), Severity of Illness Index (MeSH), Stroke (epidemiology), Stroke (therapy), Telemedicine (MeSH), Treatment Outcome (MeSH).
- MESH :
- geographic , epidemiology : California.
- epidemiology : Atrial Fibrillation, Myocardial Infarction, Stroke.
- statistics & numerical data : Length of Stay.
- therapy : Stroke.
- Adult, Aged, Aged, 80 and over, Ambulances, Betacoronavirus, Cohort Studies, Comorbidity, Coronavirus Infections, Female, Hospital Mortality, Hospitals, Community, Humans, Male, Middle Aged, Pandemics, Patient Acceptance of Health Care, Patient Discharge, Pneumonia, Viral, Severity of Illness Index, Telemedicine, Treatment Outcome.
Abstract
BACKGROUND AND PURPOSE
Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders.
METHODS
We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke.
RESULTS
Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92-104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130-136];
CONCLUSIONS
In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.
DOI: 10.1161/STROKEAHA.120.031099
PubMed: 32762619
PubMed Central: PMC7434008
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Nguyen-Huynh</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</nlm:affiliation><wicri:noCountry code="subField">J.G.K.).</wicri:noCountry></affiliation></author><author><name sortKey="Tang, Xian Nan" sort="Tang, Xian Nan" uniqKey="Tang X" first="Xian Nan" last="Tang">Xian Nan Tang</name><affiliation><nlm:affiliation>Department of Neurology (X.N.T.), Kaiser Permanente Northern California, Sacramento.</nlm:affiliation><wicri:noCountry code="subField">Sacramento</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Roseville (X.N.T.).</nlm:affiliation><wicri:noCountry code="subField">Roseville (X.N.T.).</wicri:noCountry></affiliation></author><author><name sortKey="Vinson, David R" sort="Vinson, David R" uniqKey="Vinson D" first="David R" last="Vinson">David R. 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Alexander</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</nlm:affiliation><wicri:noCountry code="subField">J.G.K.).</wicri:noCountry></affiliation></author><author><name sortKey="Meighan, Melissa" sort="Meighan, Melissa" uniqKey="Meighan M" first="Melissa" last="Meighan">Melissa Meighan</name><affiliation><nlm:affiliation>Kaiser Permanente Foundation Hospitals, Northern California, Oakland (M.M.).</nlm:affiliation><wicri:noCountry code="subField">Oakland (M.M.).</wicri:noCountry></affiliation></author><author><name sortKey="Burnett, Molly" sort="Burnett, Molly" uniqKey="Burnett M" first="Molly" last="Burnett">Molly Burnett</name><affiliation><nlm:affiliation>Department of Neurology (M.B.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation></author><author><name sortKey="Sidney, Stephen" sort="Sidney, Stephen" uniqKey="Sidney S" first="Stephen" last="Sidney">Stephen Sidney</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation></author><author><name sortKey="Klingman, Jeffrey G" sort="Klingman, Jeffrey G" uniqKey="Klingman J" first="Jeffrey G" last="Klingman">Jeffrey G. Klingman</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32762619</idno><idno type="pmid">32762619</idno><idno type="doi">10.1161/STROKEAHA.120.031099</idno><idno type="pmc">PMC7434008</idno><idno type="wicri:Area/Main/Corpus">000776</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000776</idno><idno type="wicri:Area/Main/Curation">000776</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000776</idno><idno type="wicri:Area/Main/Exploration">000776</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic.</title><author><name sortKey="Nguyen Huynh, Mai N" sort="Nguyen Huynh, Mai N" uniqKey="Nguyen Huynh M" first="Mai N" last="Nguyen-Huynh">Mai N. Nguyen-Huynh</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</nlm:affiliation><wicri:noCountry code="subField">J.G.K.).</wicri:noCountry></affiliation></author><author><name sortKey="Tang, Xian Nan" sort="Tang, Xian Nan" uniqKey="Tang X" first="Xian Nan" last="Tang">Xian Nan Tang</name><affiliation><nlm:affiliation>Department of Neurology (X.N.T.), Kaiser Permanente Northern California, Sacramento.</nlm:affiliation><wicri:noCountry code="subField">Sacramento</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Roseville (X.N.T.).</nlm:affiliation><wicri:noCountry code="subField">Roseville (X.N.T.).</wicri:noCountry></affiliation></author><author><name sortKey="Vinson, David R" sort="Vinson, David R" uniqKey="Vinson D" first="David R" last="Vinson">David R. Vinson</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Emergency Medicine (D.R.V.), Kaiser Permanente Northern California, Sacramento.</nlm:affiliation><wicri:noCountry code="subField">Sacramento</wicri:noCountry></affiliation></author><author><name sortKey="Flint, Alexander C" sort="Flint, Alexander C" uniqKey="Flint A" first="Alexander C" last="Flint">Alexander C. Flint</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Redwood City (A.C.F.).</nlm:affiliation><wicri:noCountry code="subField">Redwood City (A.C.F.).</wicri:noCountry></affiliation></author><author><name sortKey="Alexander, Janet G" sort="Alexander, Janet G" uniqKey="Alexander J" first="Janet G" last="Alexander">Janet G. Alexander</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</nlm:affiliation><wicri:noCountry code="subField">J.G.K.).</wicri:noCountry></affiliation></author><author><name sortKey="Meighan, Melissa" sort="Meighan, Melissa" uniqKey="Meighan M" first="Melissa" last="Meighan">Melissa Meighan</name><affiliation><nlm:affiliation>Kaiser Permanente Foundation Hospitals, Northern California, Oakland (M.M.).</nlm:affiliation><wicri:noCountry code="subField">Oakland (M.M.).</wicri:noCountry></affiliation></author><author><name sortKey="Burnett, Molly" sort="Burnett, Molly" uniqKey="Burnett M" first="Molly" last="Burnett">Molly Burnett</name><affiliation><nlm:affiliation>Department of Neurology (M.B.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation></author><author><name sortKey="Sidney, Stephen" sort="Sidney, Stephen" uniqKey="Sidney S" first="Stephen" last="Sidney">Stephen Sidney</name><affiliation><nlm:affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</nlm:affiliation><wicri:noCountry code="subField">Oakland</wicri:noCountry></affiliation></author><author><name sortKey="Klingman, Jeffrey G" sort="Klingman, Jeffrey G" uniqKey="Klingman J" first="Jeffrey G" last="Klingman">Jeffrey G. Klingman</name></author></analytic><series><title level="j">Stroke</title><idno type="eISSN">1524-4628</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Ambulances (MeSH)</term><term>Atrial Fibrillation (epidemiology)</term><term>Betacoronavirus (MeSH)</term><term>California (epidemiology)</term><term>Cohort Studies (MeSH)</term><term>Comorbidity (MeSH)</term><term>Coronavirus Infections (MeSH)</term><term>Female (MeSH)</term><term>Hospital Mortality (MeSH)</term><term>Hospitals, Community (MeSH)</term><term>Humans (MeSH)</term><term>Length of Stay (statistics & numerical data)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Myocardial Infarction (epidemiology)</term><term>Pandemics (MeSH)</term><term>Patient Acceptance of Health Care (MeSH)</term><term>Patient Discharge (MeSH)</term><term>Pneumonia, Viral (MeSH)</term><term>Severity of Illness Index (MeSH)</term><term>Stroke (epidemiology)</term><term>Stroke (therapy)</term><term>Telemedicine (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acceptation des soins par les patients (MeSH)</term><term>Accident vasculaire cérébral (thérapie)</term><term>Accident vasculaire cérébral (épidémiologie)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Ambulances (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Californie (épidémiologie)</term><term>Comorbidité (MeSH)</term><term>Durée du séjour (statistiques et données numériques)</term><term>Femelle (MeSH)</term><term>Fibrillation auriculaire (épidémiologie)</term><term>Humains (MeSH)</term><term>Hôpitaux communautaires (MeSH)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Infarctus du myocarde (épidémiologie)</term><term>Infections à coronavirus (MeSH)</term><term>Mortalité hospitalière (MeSH)</term><term>Mâle (MeSH)</term><term>Pandémies (MeSH)</term><term>Pneumopathie virale (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Sortie du patient (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Télémédecine (MeSH)</term><term>Études de cohortes (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>California</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Atrial Fibrillation</term><term>Myocardial Infarction</term><term>Stroke</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Length of Stay</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Durée du séjour</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Stroke</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Accident vasculaire cérébral</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Accident vasculaire cérébral</term><term>Californie</term><term>Fibrillation auriculaire</term><term>Infarctus du myocarde</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Ambulances</term><term>Betacoronavirus</term><term>Cohort Studies</term><term>Comorbidity</term><term>Coronavirus Infections</term><term>Female</term><term>Hospital Mortality</term><term>Hospitals, Community</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Patient Acceptance of Health Care</term><term>Patient Discharge</term><term>Pneumonia, Viral</term><term>Severity of Illness Index</term><term>Telemedicine</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Acceptation des soins par les patients</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Ambulances</term><term>Betacoronavirus</term><term>Comorbidité</term><term>Femelle</term><term>Humains</term><term>Hôpitaux communautaires</term><term>Indice de gravité de la maladie</term><term>Infections à coronavirus</term><term>Mortalité hospitalière</term><term>Mâle</term><term>Pandémies</term><term>Pneumopathie virale</term><term>Résultat thérapeutique</term><term>Sortie du patient</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Télémédecine</term><term>Études de cohortes</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND AND PURPOSE</b></p><p>Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92-104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130-136]; </p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32762619</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>08</Day></DateCompleted><DateRevised><Year>2020</Year><Month>10</Month><Day>08</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1524-4628</ISSN><JournalIssue CitedMedium="Internet"><Volume>51</Volume><Issue>10</Issue><PubDate><Year>2020</Year><Month>10</Month></PubDate></JournalIssue><Title>Stroke</Title><ISOAbbreviation>Stroke</ISOAbbreviation></Journal><ArticleTitle>Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic.</ArticleTitle><Pagination><MedlinePgn>2918-2924</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1161/STROKEAHA.120.031099</ELocationID><Abstract><AbstractText Label="BACKGROUND AND PURPOSE">Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders.</AbstractText><AbstractText Label="METHODS">We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke.</AbstractText><AbstractText Label="RESULTS">Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92-104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130-136]; <i>P</i><0.001). Stroke discharges also dropped, in concordance with acute stroke alerts decrease. In total, 9120 patients were included: 8337 in pre- and 783 in post-SIP cohorts. There were no differences in patient demographics. Compared with pre-SIP, post-SIP patients had higher National Institutes of Health Stroke Scale scores (<i>P</i>=0.003), lower comorbidity score (<i>P</i><0.001), and arrived more often by ambulance (<i>P</i><0.001). Post-SIP, more patients had large vessel occlusions (<i>P</i>=0.03), and there were fewer stroke mimics (<i>P</i>=0.001). Discharge outcomes were similar for post-SIP and pre-SIP cohorts.</AbstractText><AbstractText Label="CONCLUSIONS">In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Nguyen-Huynh</LastName><ForeName>Mai N</ForeName><Initials>MN</Initials><AffiliationInfo><Affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tang</LastName><ForeName>Xian Nan</ForeName><Initials>XN</Initials><AffiliationInfo><Affiliation>Department of Neurology (X.N.T.), Kaiser Permanente Northern California, Sacramento.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Neurology, Kaiser Permanente Northern California, Roseville (X.N.T.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vinson</LastName><ForeName>David R</ForeName><Initials>DR</Initials><AffiliationInfo><Affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Emergency Medicine (D.R.V.), Kaiser Permanente Northern California, Sacramento.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Flint</LastName><ForeName>Alexander C</ForeName><Initials>AC</Initials><AffiliationInfo><Affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Neurology, Kaiser Permanente Northern California, Redwood City (A.C.F.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alexander</LastName><ForeName>Janet G</ForeName><Initials>JG</Initials><AffiliationInfo><Affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Neurology, Kaiser Permanente Northern California, Walnut Creek (M.N.N.-H., J.G.K.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meighan</LastName><ForeName>Melissa</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Kaiser Permanente Foundation Hospitals, Northern California, Oakland (M.M.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Burnett</LastName><ForeName>Molly</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Neurology (M.B.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sidney</LastName><ForeName>Stephen</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Division of Research (M.N.N.-H., D.R.V., A.C.F., J.G.A., S.S.), Kaiser Permanente Northern California, Oakland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Klingman</LastName><ForeName>Jeffrey G</ForeName><Initials>JG</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Stroke</MedlineTA><NlmUniqueID>0235266</NlmUniqueID><ISSNLinking>0039-2499</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000552" MajorTopicYN="N">Ambulances</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="N">Atrial Fibrillation</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002140" MajorTopicYN="N" Type="Geographic">California</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="Y">Coronavirus Infections</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="Y">Hospital Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006764" MajorTopicYN="Y">Hospitals, Community</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="N">Myocardial Infarction</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010342" MajorTopicYN="N">Patient Acceptance of Health Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010351" MajorTopicYN="N">Patient Discharge</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="Y">Pneumonia, Viral</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020521" MajorTopicYN="N">Stroke</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017216" MajorTopicYN="Y">Telemedicine</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">cohort studies</Keyword><Keyword MajorTopicYN="Y">coronavirus</Keyword><Keyword MajorTopicYN="Y">inpatients</Keyword><Keyword MajorTopicYN="Y">patient care</Keyword><Keyword MajorTopicYN="Y">stroke</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>8</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32762619</ArticleId><ArticleId IdType="doi">10.1161/STROKEAHA.120.031099</ArticleId><ArticleId IdType="pmc">PMC7434008</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Alexander, Janet G" sort="Alexander, Janet G" uniqKey="Alexander J" first="Janet G" last="Alexander">Janet G. Alexander</name><name sortKey="Burnett, Molly" sort="Burnett, Molly" uniqKey="Burnett M" first="Molly" last="Burnett">Molly Burnett</name><name sortKey="Flint, Alexander C" sort="Flint, Alexander C" uniqKey="Flint A" first="Alexander C" last="Flint">Alexander C. Flint</name><name sortKey="Klingman, Jeffrey G" sort="Klingman, Jeffrey G" uniqKey="Klingman J" first="Jeffrey G" last="Klingman">Jeffrey G. Klingman</name><name sortKey="Meighan, Melissa" sort="Meighan, Melissa" uniqKey="Meighan M" first="Melissa" last="Meighan">Melissa Meighan</name><name sortKey="Nguyen Huynh, Mai N" sort="Nguyen Huynh, Mai N" uniqKey="Nguyen Huynh M" first="Mai N" last="Nguyen-Huynh">Mai N. Nguyen-Huynh</name><name sortKey="Sidney, Stephen" sort="Sidney, Stephen" uniqKey="Sidney S" first="Stephen" last="Sidney">Stephen Sidney</name><name sortKey="Tang, Xian Nan" sort="Tang, Xian Nan" uniqKey="Tang X" first="Xian Nan" last="Tang">Xian Nan Tang</name><name sortKey="Vinson, David R" sort="Vinson, David R" uniqKey="Vinson D" first="David R" last="Vinson">David R. Vinson</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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