| Abstrakt: |
Introduction:We aimed to evaluate the impact of Covid-19 pandemic on stroke systems of care and outcomes within a large multi-hospital system in the Western US.Methods:Retrospective data from 37 hospitals within a large multi-hospital stroke registry was analyzed. All patients with a confirmed discharge diagnosis of stroke or TIA during the pandemic (March and April 2020) were compared to cohorts during the same periods in 2018 and 2019. Analyzed factors included demographics, stroke mechanism, admission NIHSS, reperfusion therapy rates (IV TPA and EVT), reperfusion performance metrics (door-to-CT, door-to-needle, door-to-puncture, door-to-first pass), TICI score, discharge and 90-day mRS, discharge disposition, and length of stay. Analyses were conducted using ANOVA, Kruskal-Wallis, or Person’s Chi-square test, as appropriate, adjusting for multiple comparisons.Results:Among the 7,201 analyzed patients, 2,378 (33.0%) were admitted in 2018, 2,613 (36.3%) in 2019 and 2,210 (30.7%) in 2020. Fewer patients were hospitalized with TIA during the pandemic compared to 2018 and 2019 (23.6% vs 36.8% vs 39.6%, p<.001). More patients arrived via EMS (52.2% vs 45.7% vs 45.4 %) and fewer via private car (29.8% vs 37.8% vs 38.7%) (p<.001) during the pandemic. Median door-to-CT (in minutes) (26 vs 35 vs 33, p<.001) time was significantly shorter during the pandemic. Additionally, a greater percentage of patients were treated with EVT during the pandemic (7.5 vs 5.7 vs 5.4, p=.005). Shorter arrival-to-first pass times (in minutes) occurred in 2020 compared to previous years (103 vs 119 vs 115, p=0.091) but this difference did not reach statistical significance. Fewer patients were discharged to a skilled nursing facility during the pandemic (12.7%) compared to 2018 and 2019 (15.1% and 15.2%, p=.012). There were no other significant differences in stroke admission volumes, treatment trends, or outcomes between the pandemic and pre-pandemic periods.Conclusion:Fewer walk-in strokes and TIAs were hospitalized during the pandemic while an increased rate of thrombectomy procedures occurred compared to the pre-pandemic era. Despite anticipated delays in acute stroke care, our study demonstrates improvement in key triage and treatment times and similar outcomes. |
