COVID IMPACT ON DOOR-TO-NEEDLE TIME

ABSTRACT

Background and aims: Hospital responses to COVID-19 included reorganisation of services to limit infection spread, restricted access for family members, and redeployment of staff and other resources, which may be reflected in door-to-needle time (DNT) for thrombolysis. We reviewed routinely collected data on DNT over the course of the pandemic. Methods: Routinely collected performance data on thrombolysis for acute ischaemic stroke at a large academic centre from 01/01/2018 - 31/01/2021 were collated. Data are presented as mean (95%CI). Nonparametric data were normalised with logarithmic transformation. Single and multiple comparisons were calculated using independent t-test and one-way ANOVA with post-hoc Tukey HSD test respectively. P-values of <0.05 were considered significant. Significant factors were used to create a binary logistic regression model to predict DTN time <60mins. Results: Mean DNT was 49mins (44.4-53.4) in 2018 (n=205), 40mins (36.8-44.1) in 2019 (n=203), 61min (55.8-66.1) in 2020-21 (n=154). Trends in DNT, DTCT and CTTN are presented (Figure). DNT was significantly prolonged comparing pre-COVID 44mins (42.1-47.6) and post-COVID 63.1mins (58.1-69.1) periods (t(560)=6.177,p<0.01), mean difference 18.9mins (12.9-25.0). Regression analysis revealed the odds of DNT <60mins were reduced by 94% during the post-COVID period (CI=0.009-0.379,p<0.01), adjusted for NIHSS, year of presentation, anticoagulation at onset and hospital transfer status. The model displayed significant predictive power, AUROC 0.771 (0.712-0.830,p<0.01). Conclusion: COVID-19 has adversely impacted impact on our DNT and was associated with increase of 18mins compared with pre-pandemic and decreased odds of DNT <60mins. Limited data on specific factors modified in response to the pandemic limit conclusions. (Figure Presented).