Effect of the COVID-19 pandemic on treatment metrics for large vessel occlusion stroke at Box Hill Hospital

ABSTRACT

Background: The COVID-19 pandemic has disrupted modern healthcare and delayed time to acute stroke treatment at some centres internationally. The effect of the pandemic on time metrics in patients with a large vessel occlusion (LVO) at Australian stroke centres is unknown. Aim(s) To evaluate time metrics for patients with an LVO transferred from a primary stroke centre (PSC) to a comprehensive stroke centre (CSC), during and before the coronavirus pandemic. Method(s) Retrospective analysis of consecutive patients with an LVO who were transferred from a single PSC to any of three CSCs were enrolled. The pandemic period was defined as the 24 months following the March 2020 state of emergency declaration in Melbourne, and prepandemic period the preceding 24 months. "Door-in" was the time triaged as a stroke, and "Door-out" was the time ambulance staff departed. Result(s) 159 patients were included, 82 in the pandemic group and 77 in the pre-pandemic group. There were no significant differences between groups in patient age, sex, modified Rankin scale score, or National Institute of Health Stroke Scale score. Door-in to Door-out (DIDO) times were reduced during the pandemic (median 52 vs 66 minutes, IQR 41-66 vs 52-95 minutes, p<0.001). There was no change in time from PSC Door-in to the first CSC DSA images (median 125 vs 125 minutes, p=0.79). Within the DIDO workflow, the only significantly different metric was time from CSC advising of patient acceptance to PSC door-out, which improved (median 8 vs 14 minutes, p=0.016). DIDO times out of hours when the stroke registrar was called in also improved (median 51 vs 87 minutes, p=0.003). Conclusion(s) The median DIDO times at our PSC improved during the pandemic. Further studies are required to determine if this is due to a continued quality improvement program at our centre, or due to other factors.