@article {Atchieneurintsurg-2021-017415, author = {Benjamin Atchie and Stephanie Jarvis and Erica Stoddard and Kristin Salottolo and Amy Nieberlein and Kathryn McCarthy and Russell Bartt and Alicia Bennett and Christian Burrell and Donald Frei and David Bar-Or}, title = {Implementing the SNIS recommendations for neurointerventional emergent care in the setting of COVID-19: impact on stroke metrics and patient outcomes}, elocation-id = {neurintsurg-2021-017415}, year = {2021}, doi = {10.1136/neurintsurg-2021-017415}, publisher = {British Medical Journal Publishing Group}, abstract = {Background It is not clear whether the COVID-19 pandemic and subsequent Society of Neurointerventional Surgery (SNIS) recommendations affected hospital stroke metrics.Methods This retrospective cohort study compared stroke patients admitted to a comprehensive stroke center during the COVID-19 pandemic April 1 2020 to June 30 2020 (COVID-19) to patients admitted April 1 2019 to June 30 2019. We examined stroke admission volume and acute stroke treatment use.Results There were 637 stroke admissions, 52\% in 2019 and 48\% during COVID-19, with similar median admissions per day (4 vs 3, P=0.21). The proportion of admissions by stroke type was comparable (ischemic, P=0.69; hemorrhagic, P=0.39; transient ischemic stroke, P=0.10). Acute stroke treatment was similar in 2019 to COVID-19: tPA prior to arrival (18\% vs, 18\%, P=0.89), tPA treatment on arrival (6\% vs 7\%, P=0.85), and endovascular therapy (endovascular therapy (ET), 22\% vs 25\%, P=0.54). The door to needle time was also similar, P=0.12, however, the median time from arrival to groin puncture was significantly longer during COVID-19 (38 vs 43 min, P=0.002). A significantly higher proportion of patients receiving ET were intubated during COVID-19 due to SNIS guideline implementation (45\% vs 96\%, P\<0.0001). There were no differences by study period in discharge mRS, P=0.84 or TICI score, P=0.26.Conclusions The COVID-19 pandemic did not significantly affect stroke admission volume or acute stroke treatment utilization. Outcomes were not affected by implementing SNIS guidelines. Although there was a statistical increase in time to groin puncture for ET, it was not clinically meaningful. These results suggest hospitals managing patients efficiently can implement practices in response to COVID-19 without impacting outcomes.Data are available upon reasonable request.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/early/2021/03/29/neurintsurg-2021-017415}, eprint = {https://jnis.bmj.com/content/early/2021/03/29/neurintsurg-2021-017415.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }