Abstract P182: Stroke Therapy in the Time of Covid-19
Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 and was centered on the Greater New Orleans Area. Louisiana is divided into 9 regions; New Orleans is in Region 1. A statewide survey indicated 100% of hospitals experienced a decline in stroke presentations. We sought to determine if treatment of stroke with intravenous (IV) thrombolytic declined or was delayed relative to pre-COVID-19. We also sought to evaluate a change in door in-door out (DIDO) for secondary transfers among patients who screened positive for large vessel occlusions (LVO). Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared stroke volume, treatment rate with IV thrombolytic, treatment efficiency, and DIDO in 2019 with March 2020 and Q2 2020. Results: Monthly stroke presentations declined by 20% starting March 2020 compared to the average monthly volume in 2019. The IV thrombolytic rate was down from 10.3% to 8.8% in Q2 2020. In Q2 2020, the median door-to-needle time was 12 minutes longer than it was during 2019 and the proportion with a documented reason for delay increased from 29.1 in 2019 to 33.3% in March 2020 and 37.5% in Q2 2020. The median DIDO increased by 13 minutes compared to 2019 (129 vs 116 minutes). Discussion: Louisiana experienced a reduction in stroke presentation following the initial surge of COVID-19 cases. The treatment rate and efficiency with IV thrombolytic declined and DIDO was prolonged among patients with suspected LVO. Careful evaluation of how the stroke code processes changed in response to COVID-19 may help to recover efficiency in delivering acute stroke therapy.