Impact of the First Year of the COVID-19 Pandemic on Telestroke Network Performance: The Experience of a Portuguese “Drip-and-Ship” Model

Introduction: Although scarce, regional telestroke networks have been developed worlwide in the last few decades. The COVID-19 pandemic put the healthcare system under exceptional pressure. We aimed to assess the impact of the first year of the COVID-19 pandemic on the telestroke network performance in the central region of mainland Portugal. Methods: Retrospective multicenter cohort study including the eight hospitals of the regional stroke network. The first year of the COVID-19 pandemic (19/03/2020 to 18/03/2021) was compared with the period that preceded it, between 01/01/2018 and 18/03/2020. We analysed the number of telestroke consultations, the number of patients transferred for endovascular treatment, time metrics and functional outcome (measured using the modified Rankin Scale at three months). Results: The number of consultations per day and patients transferred per day for endovascular therapy increased 8.2% and 12.9% during the COVID-19 period, respectively. The period between symptom onset/last known well (LKW) moment and admission to the primary hospital (LKW – Door 1 interval) increased by 95.8 minutes (159.5 vs 255.3, p<0.01), as well as the period between admission to the primary hospital and the tertiary hospital (Door1 – Door 2 interval): an increase in 18.5 minutes; 205.6 vs 224.1, p=0.04. The Door 2 - groin puncture interval decreased by 6.7 minutes (49.4 vs 42.7, p=0.08) and the Door 2 – reperfusion period decreased by 24.2 minutes (101.9 vs 77.7, p<0.01). The functional outcome of transferred patients was not affected by the pandemic (OR 0.66 [95%CI 0.7-1.3], p=0.79). Conclusion: This study showed divergent results in different domains of the stroke care chain. Our results support the relevance of well-established telestroke networks in acute stroke care, especially during periods of high pressure on the public health systems.