Preserved acute stroke volumes and treatment metrics during the COVID 19 pandemic

ABSTRACT

Stroke is a devastating disease with high morbidity/mortality. Many studies have shown lower stroke volumes during the Covid 19 pandemic, with possible causes including fear of contracting the virus, limited hospital capacity, etc. Telemedicine (TM) helps provide safe management of stroke patients, and may be advantageous to in-person coverage during crises. The UT Teleneurology (UTT) hub provides acute neurological coverage by stroke specialists to 18 spoke centers. The impact of the pandemic on acute stroke volumes and care is ongoing and its effects should be studied further. The purpose of this study is to compare TM acute stroke volumes and time metrics between the Covid 19 era (March-June 2020) and the previous year (March-June 2019). In a retrospective query of the UTT registry from 3/19 - 6/19 and 3/20 - 6/20, we identified 294 stroke patients who received tPA - 273 were included in our analysis - 4 were excluded after quality check, 17 were excluded as inpatient strokes. We compared baseline and clinical characteristics, volumes, and time metrics between the periods (table 1). Of the 273 patients, 172 received tPA via TM during the 2019 period and 109 received tPA via TM during the 2020 period. Baseline and clinical characteristics were similar between the groups except for race. Of note, there were no differences in acute TM volumes or the number of patients receiving tPA. There was no difference in most metrics, including door to needle time. During the pandemic, camera to needle time was longer (3 minutes), and there was a trend towards longer last well to door time. There were no differences in the volume of acute TM consults, the number of patients receiving tPA, or door to needle time between the pandemic period and the previous year. Camera to needle time was slightly longer during the pandemic, perhaps representing more demands on hospital staff. The trend towards longer last well to door time could be due to public fear of presenting to the hospital during a deadly pandemic. (Figure Presented).