ABSTRACT
Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 and was centered on the Greater New Orleans Area. Louisiana is divided into 9 regions;New Orleans is in Region 1. A statewide survey indicated 100% of hospitals experienced a decline in stroke presentations. We sought to determine if treatment of stroke with intravenous (IV) thrombolytic declined or was delayed relative to pre-COVID-19. We also sought to evaluate a change in door indoor out (DIDO) for secondary transfers among patients who screened positive for large vessel occlusions (LVO). Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared stroke volume, treatment rate with IV thrombolytic, treatment efficiency, and DIDO in 2019 with March 2020 and Q2 2020. Results: Monthly stroke presentations declined by 20% starting March 2020 compared to the average monthly volume in 2019. The IV thrombolytic rate was down from 10.3% to 8.8% in Q2 2020. In Q2 2020, the median door-to-needle time was 12 minutes longer than it was during 2019 and the proportion with a documented reason for delay increased from 29.1 in 2019 to 33.3% in March 2020 and 37.5% in Q2 2020. The median DIDO increased by 13 minutes compared to 2019 (129 vs 116 minutes). Discussion: Louisiana experienced a reduction in stroke presentation following the initial surge of COVID-19 cases. The treatment rate and efficiency with IV thrombolytic declined and DIDO was prolonged among patients with suspected LVO. Careful evaluation of how the stroke code processes changed in response to COVID-19 may help to recover efficiency in delivering acute stroke therapy. (Figure Presented).
ABSTRACT
Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 in the Greater New Orleans Area and quickly spread throughout the state. We sought to determine if LVO screening and door in-door out (DIDO) among patients who screened positive for large vessel occlusions (LVO) deteriorated. Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared LVO screening and transfer efficiency during Q1 and Q2 2020 with Q3 and Q4 2019. Results: Patients presenting within 24hr of last seen normal declined by 11%. The proportion arriving by ambulance increased (50.6% vs 40.7%, p<0.0001). Screening for LVO increased (84.4% vs 77.0%%, p<0.0001). Use of Vision-Aphasia-Neglect assessment increased (74.6% vs 66.2%%, p<0.0001). The proportion screening positive for LVO insignificantly decreased (23.1% vs 26.0%, p=0.1233). The median time from door in to transfer request was stable (63min during both time periods). The median time from transfer request to departure increased (58min vs 48min). The DIDO increased by 24 minutes (135min vs 111min). Delay due to achieving acceptance in hub center and secondary transfer ambulance were the most common reasons documented for prolonged DIDO. Discussion: Louisiana experienced a reduction in acute stroke presentation during COVID-19. Screening for LVO actually improved during this time, but DIDO was compromised due to problems securing transfer acceptance and secondary ambulance service. Earlier identification and initiation of secondary transfer for patients screening positive for LVO should help improve efficiency in delivering acute stroke therapy. (Figure Presented).