Abstract TMP56: Quality Of Ischemic Stroke Care Before And After The Covid-19 Pandemic

Abstract

Objective: To compare metrics of acute care for ischemic stroke (IS) before and after the first cases of COVID-19 were diagnosed and major changes were made to the workflow. Methods: Data were prospectively collected as part of the institutional Stroke Database project. Patients with IS > 18 years admitted from January 2019 until March 2020 were considered to be part of the group treated in the “pre-COVID” era and those admitted from April 2020 until December 2020, in the “post-COVID” era. The primary outcome was the door-to-needle time in subjects treated with intravenous thrombolysis. Secondary outcomes were: rate of thrombolysis, rates of complications (pneumonia, urinary tract infection, deep venous thrombosis or pressure injury) and death during hospital admission. Patients’ characteristics, primary and secondary outcomes were compared with unpaired t-tests, Mann-Whitney or chi-square tests, according to the nature and distribution of the data. Results: Data from 932 patients with IS in the pre-COVID and 520, in the post-COVID group were prospectively collected. There were no significant differences in age (pre-COVID, 64.2±14.7 years; post-COVID, 63.3±15 years; p=0.296), gender (pre-COVID, 55.5% male; post-COVID, 55% male; p=0.862) or NIHSS scores (pre-COVID, median 5, range 0-38; post-COVID, median 6, range 0-36; p=0.346). Thrombolysis rates were 19.6% pre-COVID and15.7% post-COVID. All eligible subjects received thrombolysis. The increase in door-to-needle time in subjects treated with thrombolysis (pre-COVID, median 36 minutes; post-COVID, median 39 minutes) was statistically significant (p=0.048). Rates of complications in all ISs during admission increased significantly from 8.3% (pre-COVID) to 20.2% (post-COVID) (p<0.001). The increase in death rate from 8.4% (pre-COVID) to 12.1% (post-COVID) did not reach statistical significance (p=0.059). Conclusions: The increases in door-to-needle times, complication and death rates, despite the lack of significant differences in age or stroke severity, likely reflect the impact of the COVID-pandemic on public health care. Despite major changes in workflow, door-to-needle times were below 40 minutes in more than 50% of patients treated with thrombolysis.