Abstract 42: Epidemiological Surveillance of the Impact of the Covid-19 Pandemic on Stroke Care Using Artificial Intelligence

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Jason Davies ◽  
Rishi Gupta ◽  
Ameer E Hassan ◽  
Thomas G Devlin ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Acute Stroke ◽  
Real Time ◽  
Systems Of Care ◽  
Stroke Care ◽  
Epidemiological Surveillance ◽  
Day Hospital ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Background: The degree to which the COVID-19 pandemic has affected systems of care, in particular those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence (AI) platform. Methods: Data were derived from the Viz Platform, an AI application designed to optimize the workflow of acute stroke patients. Neuroimaging data on suspected stroke patients across 97 hospitals in 20 US states were collected in real-time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of CTA, CTP, Large vessel occlusions (LVOs) (defined according to the automated software detection), and severe strokes on CTP (defined as those with hypoperfusion volumes>70mL) normalized as number of patients per day per hospital. Data from the pre-pandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23,223 patients were included. The incidence of LVO on CTA and severe strokes on CTP were 11.2%(n=2,602) and 14.7%(n=1,229/8,328), respectively. There were significant declines in the overall number of CTAs (-22.8%;1.39 to 1.07 patients/day/hospital,p<0.001) and CTPs (-26.1%;0.50 to 0.37 patients/day/hospital,p<0.001) as well as in the incidence of LVO (-17.1%;0.15 to 0.13 patients/day/hospital,p<0.001) and severe strokes on CTP (-16.7%;0.12 to 0.10 patients/day/hospital, p<0.005). The sampled cohort showed similar declines in the rates of LVOs versus thrombectomy (18.8%vs.19.5%, p=0.9) and CSC hospitalizations (18.8%vs.11.0%, p=0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This underscores the broader application of AI neuroimaging platforms for the real-time monitoring of stroke systems of care.

scholarly journals Epidemiological Surveillance of the Impact of the COVID-19 Pandemic on Stroke Care Using Artificial Intelligence

Stroke ◽  
2021 ◽  
Author(s):  
Raul G. Nogueira ◽  
Jason M. Davies ◽  
Rishi Gupta ◽  
Ameer E. Hassan ◽  
Thomas Devlin ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Acute Stroke ◽  
Systems Of Care ◽  
Ct Perfusion ◽  
Stroke Care ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Number Of Patients ◽  
The Impact

Background and Purpose: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence platform. Methods: Data were derived from the Viz Platform, an artificial intelligence application designed to optimize the workflow of patients with acute stroke. Neuroimaging data on suspected patients with stroke across 97 hospitals in 20 US states were collected in real time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of computed tomography (CT) angiography, CT perfusion, large vessel occlusions (defined according to the automated software detection), and severe strokes on CT perfusion (defined as those with hypoperfusion volumes >70 mL) normalized as number of patients per day per hospital. Data from the prepandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23 223 patients were included. The incidence of large vessel occlusion on CT angiography and severe strokes on CT perfusion were 11.2% (n=2602) and 14.7% (n=1229/8328), respectively. There were significant declines in the overall number of CT angiographies (−22.8%; 1.39–1.07 patients/day per hospital, P <0.001) and CT perfusion (−26.1%; 0.50–0.37 patients/day per hospital, P <0.001) as well as in the incidence of large vessel occlusion (−17.1%; 0.15–0.13 patients/day per hospital, P <0.001) and severe strokes on CT perfusion (−16.7%; 0.12–0.10 patients/day per hospital, P <0.005). The sampled cohort showed similar declines in the rates of large vessel occlusions versus thrombectomy (18.8% versus 19.5%, P =0.9) and comprehensive stroke center hospitalizations (18.8% versus 11.0%, P =0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This analysis underscores the broader application of artificial intelligence neuroimaging platforms for the real-time monitoring of stroke systems of care.

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

Abstract 3379: Benefiting the Community; The Impact of Joining a Regional Stroke Network

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nancy D Papesh ◽  
James Gebel
Keyword(s):  
Acute Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Impact ◽  
Iv Tpa

Background: The Cleveland Clinic Health System (CCHS) consists of a large tertiary care center and 10 regional hospitals. It is organized both clinically and administratively into multispecialty organ based Institutes rather than departments. The CCHS re-introduced a regional initiative to standardize stroke care in 2008. Medina Hospital is a 118-bed community hospital in rural North-eastern Ohio, where there is a high stroke burden and previously minimal IV tPA use. Medina Hospital joined the CCHS Stroke Network in November 2009. Hypothesis: We hypothesized that after joining the formally organized stroke CCHS system of care, the proportion of stroke patients receiving IV tPA and the timeliness of administration of acute thrombolytic therapy would both significantly increase. Methods: Data was analyzed from our prospective participation in the Get with the Guidelines-Stroke and the Ohio Coverdell Stroke Registries. Baseline data regarding quality, outcomes and stroke performance measures were reviewed. CCHS initially supported acute stroke care in early 2010 with a telemedicine cart and then introduced 24/7 emergency, on-site, CCHS neurologist, acute stroke call coverage in late 2010. Standardized CCHS stroke care pathways and order sets were also introduced in 2010. The proportion of stroke patients treated with IV tPA in 2010 and 2011 (post- joining CCHS) was compared to 2009 (2-sided Fisher’s exact test), and door-to-needle times were compared from 2010 to 2011 (unpaired t-test). Results: IV tPA treatment utilization increased from 0/69 patients (0%) in 2009 to 9/67 patients (11.8%) in 2010 [exact p=.0033] and 11/46 (19.3%) in the first 7 months of 2011 [exact p=.0001]. Door-to-needle times improved from a mean of 81.4 (95%CI 66.4 to 96.4) minutes in 2010 to 61.7 (95% CI 52.7 to 70.8) minutes in 2011 (p=.0158). Conclusions: Participation in an organized formal collaborative regional hospital stroke treatment network resulted in dramatic improvements from zero IV tPA utilization to greatly exceeding the national benchmark averages for both percentage treatment with IV tPA and door-to-needle time in a rural area where patients previously had minimal access to acute stroke expertise.

scholarly journals Impact of National Lockdown on the Hyperacute Stroke Care and Rapid Transient Ischaemic Attack Outpatient Service in a Comprehensive Tertiary Stroke Centre During the COVID-19 Pandemic

2021 ◽  
Vol 12 ◽  
Author(s):  
Lucio D'Anna ◽  
Maddison Brown ◽  
Sikdar Oishi ◽  
Natalya Ellis ◽  
Zoe Brown ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Outpatient Service ◽  
Stroke Care ◽  
Reperfusion Therapy ◽  
Long Term Effects ◽  
Number Of Patients ◽  
Stroke Center ◽  
Ischemic Attack ◽  
The Uk ◽  
The Impact

Background: The COVID-19 pandemic is having major implications for stroke services worldwide. We aimed to study the impact of the national lockdown period during the COVID-19 outbreak on stroke and transient ischemic attack (TIA) care in London, UK.Methods: We retrospectively analyzed data from a quality improvement registry of consecutive patients presenting with acute ischemic stroke and TIA to the Stroke Department, Imperial College Health Care Trust London during the national lockdown period (between March 23rd and 30th June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting with stroke or TIA in the same period of 2019.Results: Between March 23rd and 30th June 2020, we documented a fall in the number of stroke admissions by 31.33% and of TIA outpatient referrals by 24.44% compared to the same period in 2019. During the lockdown, we observed a significant increase in symptom onset-to-door time in patients presenting with stroke (median = 240 vs. 160 min, p = 0.020) and TIA (median = 3 vs. 0 days, p = 0.002) and a significant reduction in the total number of patients thrombolysed [27 (11.49%) vs. 46 (16.25%, p = 0.030)]. Patients in the 2020 cohort presented with a lower median pre-stroke mRS (p = 0.015), but an increased NIHSS (p = 0.002). We registered a marked decrease in mimic diagnoses compared to the same period of 2019. Statistically significant differences were found between the COVID and pre-COVID cohorts in the time from onset to door (median 99 vs. 88 min, p = 0.026) and from onset to needle (median 148 vs. 126 min, p = 0.036) for thrombolysis whilst we did not observe any significant delay to reperfusion therapies (door-to-needle and door-to-groin puncture time).Conclusions: National lockdown in the UK due to the COVID-19 pandemic was associated with a significant decrease in acute stroke admission and TIA evaluations at our stroke center. Moreover, a lower proportion of acute stroke patients in the pandemic cohort benefited from reperfusion therapy. Further research is needed to evaluate the long-term effects of the pandemic on stroke care.

Abstract P268: Community Wide Real-Time Stroke Code Capture to Better Identify Changes in Health Care Utilization During Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Amelia Kenner Brininger ◽  
Lindsay L Olson-Mack ◽  
Lorraine Chmielowski ◽  
Kristi L Koenig ◽  
Mary A Kalafut ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Real Time ◽  
Healthcare Utilization ◽  
San Diego ◽  
San Diego County ◽  
Discharge Data ◽  
Stroke Incidence ◽  
Number Of Patients ◽  
Stroke Center ◽  
The Impact

Introduction: Many healthcare systems reported a decline in stroke admissions in the early months of the COVID-19 pandemic. We used real-time hospital admission data from Stroke Receiving Centers (SRCs) across San Diego County to quantify changes in stroke patients accessing healthcare with the onset of the COVID-19 pandemic. Rather than waiting for months-delayed discharge data, real-time stroke code data was used to understand the impact on healthcare utilization which may better inform mitigation strategies to encourage accessing care for acute stroke. Methods: We analyzed the total number of patients presenting to any of the 18 San Diego County SRCs for which a stroke code was activated between January 1, 2019 and July 31, 2020; and separated the times into: pre-pandemic (PP) as January 2019 thru February 2020, early-pandemic (EP) as March and April 2020, and mid-pandemic (MP) as May-July 2020. Patients arriving via emergency medical services or private transport were included. A public messaging campaign regarding the safety of accessing care for acute stroke started in early May 2020. Results: A total of 14,028 stroke codes were initiated between January 2019 and July 2020. An average of 43.2 stroke codes were activated per stroke center per month (range=39.6 to 46.7 activations per stroke center per month) during PP, 30.6 during EP and 37.7 during MP (p=.019). Overall, 30% fewer stroke code activations occurred during EP compared to the same months in the PP (p=.012). Mid-pandemic, there were 14.6% fewer stroke code activations compared to the same months pre-pandemic (p=.095). Conclusion: Stroke code activations decreased by 30% across San Diego County SRCs in the EP period compared to the previous year. It is unclear if this is primarily due to decreased healthcare utilization at the start of the COVID-19 pandemic or if there were changes in stroke incidence. MP showed stroke code activations increased compared to EP. This may be partially due to the public messaging campaign initiated after an analysis of PP to EP stroke code activations. We will continue to analyze stroke code data to better understand the impact of public messaging campaigns and determine when activations have returned to PP levels.

scholarly journals Implementing the NHS England Long Term Plan for stroke: how should reperfusion services be configured? A modelling study

2021 ◽  
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Gary A. Ford ◽  
Phil White ◽  
Anthony Rudd ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Computer Modelling ◽  
Systems Of Care ◽  
Stroke Care ◽  
Net Benefit ◽  
Acute Stroke Care ◽  
Modest Improvement ◽  
Secondary Transfer ◽  
The Cost ◽  
The Impact

Objectives: To guide policy when planning reperfusion thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between ‘mothership’ (direct conveyance to an MT centre) and ‘drip-and-ship' (secondary transfer for MT after local IVT) provision and the impact of bypassing local acute stroke centres.Methods: Computer modelling was used to estimate the likely outcomes from reperfusion therapies, along with admission numbers to units, based on expected times to IVT and MT.Results: Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit accrues from direct conveyance to an IVT/MT centre. If this model was followed then net benefit from reperfusion is predicted to be increased from 31 to 34 additional disability-free outcomes / 1,000 admissions. However, this policy produces unsustainable admission numbers at these centres, and depletes all but 19 IVT-only units of all stroke admissions. Implementing a maximum permitted additional travel time to bypass an IVT-only unit, or using a pre-hospital test for LAO, both increase net benefit over the current drip-and-ship model, but produce a similar destabilising effect on acute systems of care. Use of IVT-only units manage admission numbers to IVT/MT centres.Conclusions: The mothership model reduces time to MT at the cost of increased time to IVT, but the benefit of faster MT is predicted to lead to a modest improvement in overall outcomes. Providing a sustainable national system of acute stroke care requires a hybrid of mothership and drip-and-ship provision.

The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre

2020 ◽  
pp. 1357633X2092103
Author(s):  
Scott Gutovitz ◽  
Jonathan Leggett ◽  
Leslie Hart ◽  
Samuel M Leaman ◽  
Heather James ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Care Guidelines ◽  
Stroke Center ◽  
The Impact ◽  
Stroke Centre

Introduction We evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; tele-neurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and tele-neurology (90.4 ± 33.4 min; p = 0.67). Discussion At this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

Evaluation of Stroke in the Emergency Department

2018 ◽  
pp. 78-96
Author(s):  
Robert Sawyer ◽  
Edward C. Jauch
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Systems Of Care ◽  
Supportive Therapy ◽  
Stroke Care ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Intravenous Alteplase ◽  
Get With The Guidelines ◽  
Therapy Quality

Acute stroke remains a challenge due to the myriad of presentations and the narrow therapeutic windows for reperfusion therapies. This chapter reviews the Emergency Department (ED) initial evaluation and treatment of stroke, recognition of potential stroke patients, and ED-based systems of care to optimize stroke care for the various forms of stroke encountered in the ED. The chapter also covers therapy options, including intravenous alteplase, endovascular thrombectomy, and supportive therapy. Quality assurance and feedback is addressed through Get with the Guidelines-Stroke. Common scenarios and pitfalls that are frequently encountered when evaluating patients with acute stroke in the ED are discussed.

National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study

2021 ◽  
pp. 239698732110633
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Gary A Ford ◽  
Phil White ◽  
Anthony G Rudd ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Travel Time ◽  
Stroke Care ◽  
Large Artery ◽  
Number Of Patients ◽  
National Implementation ◽  
Selection For ◽  
The Impact ◽  
Care System ◽  
Modelling Study

Objectives To guide policy when planning thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between ‘mothership’ (direct conveyance to an MT centre) and ‘drip-and-ship’ (secondary transfer) provision and the impact of bypassing local acute stroke centres. Design Outcome-based modelling study. Setting 107 acute stroke centres in England, 24 of which provide IVT and MT (IVT/MT centres) and 83 provide only IVT (IVT-only units). Participants 242,874 emergency admissions with acute stroke over 3 years (2015–2017). Intervention Reperfusion delivered by drip-and-ship, mothership or ‘hybrid’ models; impact of additional travel time to directly access an IVT/MT centre by bypassing a more local IVT-only unit; effect of pre-hospital selection for large artery occlusion (LAO). Main outcome measures Population benefit from reperfusion, time to IVT and MT, admission numbers to IVT-only units and IVT/MT centres. Results Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit, assuming unknown patient status, accrues from direct conveyance to an IVT/MT centre. However, this policy produces unsustainable admission numbers at these centres, with 78 out of 83 IVT-only units receiving fewer than 300 admissions per year (compared to 3 with drip-and-ship). Implementing a maximum permitted additional travel time to bypass an IVT-only unit, using a pre-hospital test for LAO, and selecting patients based on stroke onset time, all help to mitigate the destabilising effect but there is still some significant disruption to admission numbers, and improved selection of patients suitable for MT selectively reduces the number of patients who would receive IVT at IVT-only centres, challenging the sustainability of IVT expertise in IVT-only centres. Conclusions Implementation of reperfusion for acute stroke based solely on achieving the maximum population benefit potentially leads to destabilisation of the emergency stroke care system. Careful planning is required to create a sustainable system, and modelling may be used to help planners maximise benefit from reperfusion while creating a sustainable emergency stroke care system.

Abstract P183: Preserved Acute Stroke Volumes and Treatment Metrics During the Covid 19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Maria V Diaz Rojas ◽  
Liang Zhu ◽  
Tzu-ching Wu ◽  
Christy T Ankrom ◽  
Alicia Zha ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Characteristics ◽  
Hospital Staff ◽  
High Morbidity ◽  
Stroke Patients ◽  
Hospital Capacity ◽  
Safe Management ◽  
Number Of Patients ◽  
Quality Check ◽  
The Impact

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.

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