ABSTRACT
Objective: To evaluate stroke code time metrics and frequency of rt-PA administration in emergency department (ED) stroke codes evaluated at bedside versus telemedicine. Background: Telemedicine allows for increased access to acute stroke care. Data must be examined regarding differences in stroke code time metrics and acute thrombolytic use in Hub bedside compared to Spoke telemedicine evaluations to optimize care. Design/Methods: We retrospectively reviewed prospectively collected data from an IRBapproved registry. The sample included consecutive stroke code activations at an academic, Comprehensive Stroke Center evaluated at bedside (BG) compared to aggregate telemedicine sites (TG) from 10/1/2013-6/30/2020. We included all rt-PA treated patients. Providers were the same in both groups. We assessed 1) time from ED arrival to treatment decision, 2) ED arrival to rt-PA administration, and 3) treatment rates between groups. Groups were compared via chi-squared, logistic regression, t-test, and Pairwise Wilcoxon where appropriate. Analyses were unadjusted and adjusted for NIHSS as appropriate. Results: In total, 876 patients received rt-PA. There was no significant difference in patients receiving IV rt-PA only versus IV rt-PA and endovascular therapy between BG and TG (p=0.45). There was no significant difference in time from ED arrival to treatment decision between groups ((xBG 35.0 min vs TG 35.0 min;χBG: 35.3 min vs TG: 37.7 min;p=0.09). There was no significant difference in time from ED arrival to rt-PA administration between groups (xBG 53.0 min vs TG 55.0 min;χBG: 57.2 min vs TG: 58.3 min;p=0.69). There was no difference in rt-PA treatment rates amongst the telemedicine spoke sites (p=0.45). Conclusions: There were no significant differences in stroke code time metrics or rt-PA treatment rates in beside versus telemedicine stroke assessments in this study. Ensuring parity in stroke code evaluation is critical as telemedicine use increases due to the COVID-19 pandemic and its implication on the future of healthcare.
ABSTRACT
Introduction: The COVID-19 pandemic forced immediate changes to stroke code protocols to maintain safety of patients and providers. We hypothesize that stroke code time metrics were significantly longer in the peri-COVID stroke code activations compared to pre-COVID activations. Methods: We analyzed data from an IRB-approved, prospectively collected stroke registry at a large academic, comprehensive stroke center (CSC). We included all patients that presented as stroke code activations from June 2009-August 2020, excluding spoke telestroke and in-house codes. Pre-COVID was defined as June 1, 2009-March 11, 2020 and peri-COVID March 12, 2020 to August 11, 2020. The pre-pandemic stroke code protocol began June 2009. We assessed The Joint Commission stroke code time metrics between groups. Demographic variables of baseline NIHSS, sex, race/ethnicity, age, smoking, pertinent past medical history, arrival mode, and baseline glucose were assessed. A t-test was used to compare stroke code time metrics in minutes. All analyses were done unadjusted. Results: We assessed 813 pre and 328 peri-COVID stroke code activations. Baseline demographics were significant only for an increased number of Hispanics in the pre-COVID group (22.9% vs 11.1%, p<0.001). Onset to hospital arrival time was significantly longer in the peri-COVID compared to pre-COVID group (244 vs 110 min, p<0.001). Onset to stroke code activation was significantly longer in the peri-COVID compared to pre-COVID group (243.8 vs 116.8 min, p<0.009). Time from arrival to treatment decision was significantly decreased in the peri-COVID group (29.9 vs 39.6 min, p=0.04). Time from arrival to CT scan completed (p=0.37), arrival to treatment administration (p=0.06), and onset to treatment administration (p=0.48) were not significantly different between groups. Conclusion: The COVID-19 pandemic significantly impacted the volume and demographic of stroke patients seeking emergency care. This data supports the trend of patients delaying emergent stroke care. This academic, CSC developed and implemented a COVID-19 stroke code protocol within days of a statewide lockdown. The use of telestroke in this peri-pandemic protocol may have accounted for the significant decrease in time to treatment decision.