Impact of COVID-19 pandemic on pre-hospital and in-hospital time-dependent performance measures of treatment of patients with acute ischemic stroke - experience of a tertiary healthcare center

Abstract

Introduction/Objective. The outbreak of COVID-19 pandemic has posed major challenges to the process of urgent care of patients with acute ischemic stroke (AIS) that requires optimal and well-coordinated pre- and in-hospital chains in order to enable recanalization therapy commencement the earliest possible. The study?s objection was to compare time-dependent performance measures and treatment results of patients with AIS hospitalized at a tertiary healthcare center before and during COVID 19 pandemic. Methods. Retrospective analysis was performed on AIS patients treated with recanalization therapy at Emergency Neurology Department of University Clinical Centre of Serbia, during the March-June period of years 2019, 2020, and 2021. Besides demographic and clinical characteristics, for each patient were calculated: time elapsed from stroke onset to hospital arrival (?onset-to-door"), from hospitalization to the beginning of recanalization therapy (?door-to-needle") and total time that elapsed from symptoms?s onset to treatment initiation (?onset-to-needle"). Patients? functional outcome was assessed after three months by using modified Rankin scale (mRS) score. Results.Total of 84 patients were included (25/2019, 30/2020 and 29/2021; [p= 0.512]). No statistical significance was detected regarding age, gender, severity of stroke symptoms at hospital admission or type of received recanalization therapy. Our study showed no statistical difference regarding time needed to reach the hospital (p=0.441), ?door-to-needle" time (p = 0.549), nor overall times elapsed from symptoms onset to therapy (p=0.481) among three groups of patients. Furthermore, comparison of patients? three-month functional outcomes didn?t show statistical significance (p = 0.922). Conclusion: This experienced tertiary healthcare system has shown notable resilience to the side-effects of COVID-19 pandemic.