Abstract Body: Introduction: Stroke is the fifth leading cause of death and long-term disability in the United
States with an estimated prevalence of 7 million individuals affected as of 2019. Protocols for
stroke management established by the American Heart Association (AHA) and American Stroke
Association (ASA) include a 25-minute timeframe from door to CT time (DTCT). Adapting to
challenges during the COVID-19 pandemic likely increased the DTCT in acute stroke patients
from various sociodemographic backgrounds.
Methods: We aimed to identify factors affecting the DTCT time for a cohort of over 23,000
patients between January 2018 and August 2022. The primary endpoint was DTCT ≤25 minutes
upon arrival to hospital for all patients suspected of acute ischemic stroke. Race and ethnicity
were self-reported.
Results: We have identified patient race and post-COVID timing of care as two factors with
statistically significant effects on DTCT time. 4,468 patients (19.1%) had DTCT times less than
or equals to 25 minutes, and 16,464 patients (70.5%) had DTCT times more than 25 minutes.
Patients in the pre-COVID, COVID, and post-COVID phases were 6,852 (29.3%), 13,593
(58.2%) and 2,919 (12.5%), respectively. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and
Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT >25 minutes compared to White patients. Hispanic patients (OR 1.20; 95% C1 1.07-1.34) were more likely to
have DTCT >25 minutes compared to non-Hispanics. Patients presenting during COVID (OR
1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely
to have DTCT >25 minutes compared to the pre-COVID period.
Conclusion: Therefore, we demonstrated a discrepancy in DTCT time for acute ischemic stroke
patients based on their race and ethnic population. We also observed an increase in DTCT time
after the start of COVID-19 which has persisted after the pandemic. These diverse factors
highlight the complex interplay of logistical, organizational, and healthcare challenges that have
influenced DTCT time. Identifying disparities can help address inequities and ensure that all
patients, regardless of background, receive timely care.