| Abstract | Objectives: Acute ischemic stroke (AIS) is a frequently encountered and severe medical emergency needing rapid intervention. This thesis aimed to investigate whether the COVID-19 pandemic has resulted in an increase in the duration of the workflow associated with Mechanical Thrombectomy (MT) treatment for patients with acute ischemic stroke.
Material and methods: This retrospective cohort study analyzed 218 subjects who MT at REGIOMED hospitals in Coburg, Sonneberg, and Lichtenfels, both before and during the COVID-19 pandemic. Data were extracted from the ORBIS system covering patients with occlusions in various cerebral arteries who underwent thrombectomy from January 1st 2017, to March 31st, 2022. We compared door-to-picture (DTP) and picture-to-puncture (PTP) values between two groups: a control group, the Pre COVID-19 group (PreCP) comprising subjects who underwent thrombectomy before the pandemic (January 1st, 2017, to January 31st, 2020), and an experimental group, the During COVID-19 group (DurCP) comprising subjects treated during the pandemic (March 1st, 2020, to March 31st, 2022). Statistical analyses were performed using the Wilcoxon Rank Sum Test due to non-normal distributions, with a significance level value set at 𝛼 = 0.05. Data visualization and summary statistics were conducted using R software and specific packages, including ggplot2 and car.
Results: Prior to the COVID-19 pandemic, median DTP time was 12 minutes (interquartile range (IQR) = 10.80), increasing slightly to 15 minutes (IQR = 11.50) during the pandemic. Similarly, PTP time increased from a median of 75 minutes (IQR = 57.50) pre-pandemic to 82 minutes (IQR = 54.50) during the pandemic, reflecting a difference of 3 and 7 minutes.
We found a non-normal distribution of data in all four groups, confirmed through visual inspection and the Shapiro-Wilk test. With significant deviations from normality, nonparametric tests were chosen for subsequent analyses. Utilizing the Wilcoxon Rank Sum Test, significant increases in DTP and PTP times during the pandemic were observed (DTP: W = 2895.5, P = 0.003, r = 0.17; PTP: W = 4669.5, P = 0.01, r = 0.17), although effect sizes were small according to Cohen’s classification.
Conclusion: Both DTP and PTP times showed increases during the pandemic period compared to pre-pandemic levels, with PTP times notably rising by approximately 18 minutes. Median values for both DTP and PTP times were notably higher during the pandemic, indicating longer durations, possibly influenced by workflow shifts, external factors during the pandemic, or measurement errors. While the effect size was small according to conventional guidelines, statistical significance was found in both DTP and PTP times. However, caution is warranted in interpreting these findings, considering potential confounding factors. Further investigation is needed to understand factors contributing to workflow variations and to identify interventions to enhance efficiency. |
| Abstract (croatian) | Ciljevi: Akutni ishemijski moždani udar (AIM) je često susretana i ozbiljna medicinska hitnost koja zahtijeva brzu intervenciju. Ovaj rad je imao za cilj istražiti je li pandemija COVID-19 rezultirala povećanjem trajanja radnog tijeka povezanog s liječenjem mehaničkom trombektomijom (MT) kod pacijenata s akutnim ishemijskim moždanim udarom.
Materijal i metode: Ova retrospektivna kohortna studija analizirala je 218 ispitanika koji su podvrgnuti MT u bolnicama REGIOMED u Coburgu, Sonnebergu i Lichtenfelsu, kako prije, tako i tijekom pandemije COVID-19. Podaci su izvučeni iz ORBIS sustava, pokrivajući pacijente s okluzijama u različitim cerebralnim arterijama koji su podvrgnuti trombektomiji od 1. siječnja 2017. do 31. ožujka 2022. godine. Uspoređivali smo vrijednosti od ulaska do snimanja (DTP) i od snimanja do punkcije (PTP) između dvije skupine: kontrolne skupine, Pre COVID-19 skupine (PreCP) koja obuhvaća ispitanike koji su podvrgnuti trombektomiji prije pandemije (1. siječnja 2017. do 31. siječnja 2020.) i eksperimentalne skupine, Tijekom COVID-19 skupine (DurCP) koja obuhvaća ispitanike liječene tijekom pandemije (1. ožujka 2020. do 31. ožujka 2022.). Statističke analize provedene su korištenjem Wilcoxonovog testa zbroja rangova zbog nenormalnih raspodjela, s razinom značajnosti postavljenom na 𝛼 = 0,05. Vizualizacija podataka i sažetak statistika provedeni su korištenjem R softvera i specifičnih paketa, uključujući ggplot2 i car.
Rezultati: Prije pandemije COVID-19, medijan DTP vremena bio je 12 minuta (interkvartilni raspon (IQR) = 10,80), blago se povećavajući na 15 minuta (IQR = 11,50) tijekom pandemije. Slično tome, PTP vrijeme povećalo se s medijana od 75 minuta (IQR = 57,50) prije pandemije na 82 minute (IQR = 54,50) tijekom pandemije, što odražava razliku od 3 i 7 minuta. Utvrdili smo nenormalnu distribuciju podataka u sve četiri skupine, potvrđenu vizualnom inspekcijom i Shapiro-Wilkovim testom. Zbog značajnih odstupanja od normalnosti, za daljnje analize odabrani su neparametrijski testovi. Korištenjem Wilcoxonovog testa zbroja rangova, tijekom pandemije zabilježena su značajna povećanja DTP i PTP vremena (DTP: W = 2895,5, P = 0,003, r = 0,17; PTP: W = 4669,5, P = 0,01, r = 0,17), iako su veličine učinka bile male prema Cohenovoj klasifikaciji.
Zaključak: I DTP i PTP vremena pokazala su povećanje tijekom pandemijskog razdoblja u usporedbi s razdobljem prije pandemije, pri čemu su PTP vremena značajno porasla za približno 18 minuta. Medijan vrijednosti za oba DTP i PTP vremena bio je značajno veći tijekom pandemije, ukazujući na dulje trajanje, moguće pod utjecajem promjena u radnom tijeku, vanjskih čimbenika tijekom pandemije ili pogrešaka u mjerenju. Iako je veličina učinka bila mala prema konvencionalnim smjernicama, statistička značajnost pronađena je u oba DTP i PTP vremena. Međutim, potreban je oprez u tumačenju ovih nalaza, s obzirom na moguće zbunjujuće čimbenike. Daljnje istraživanje je potrebno kako bi se razumjeli čimbenici koji pridonose varijacijama u radnom tijeku i identificirale intervencije za poboljšanje učinkovitosti. |
