Impact of the 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

Introduction/Objective The outbreak of the 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 at the earliest possible opportunity. The objective of the study was to compare time-dependent performance measures and treatment results of patients with AIS hospitalized at a tertiary healthcare center before and during the COVID-19 pandemic.Methods A retrospective analysis was performed on AIS patients treated with recanalization therapy at the Emergency Neurology Department of the University Clinical Centre of Serbia, during the March-June period of 2019, 2020, and 2021. Besides demographic and clinical characteristics, the following were calculated for each patient: time elapsed from stroke onset to hospital arrival ("onset-to-door"), time elapsed from hospitalization to the beginning of recanalization therapy ("door-to-needle"), and total time elapsed from symptoms' onset to treatment initiation ("onset-to-needle"). The patients' functional outcome was assessed after three months by using modified Rankin Scale score.Results A total of 84 patients were included [25/2019, 30/2020, and 29/2021; (p = 0.512)]. No statistical significance was detected regarding the age, sex, severity of stroke symptoms at hospital admission, or the 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 the patients' three-month functional outcomes did not show statistical significance (p = 0.922).Conclusion The experience of this tertiary healthcare system has shown notable resilience to the side effects of the COVID-19