The Impact of a TPA Unit during the COVID-19 Pandemic on Inpatient Length of Stay and Outcomes for Ischemic Stroke

Background: Resource allocation can be problematic in ischemic stroke receiving IV thrombolysis (tPA) during COVID-19 pandemic as only a subset requires critical care interventions. It is also unknown whether the usage of non-ICU stroke unit for post-tPA care has better patient outcome compared to ICU. Methods: A pilot study in a single tertiary medical center, in which one-bed tPA unit was created in a non-ICU Stroke Unit during the COVID-19 pandemic, with the provision of ICU level of nursing care. We included 123 consecutive ischemic stroke patients treated with tPA, included in an institutional registry between October 2020 and December 2021. The primary outcome of interest was inpatient length of stay (LOS). The secondary outcome of interest was the 90-day clinical outcomes. Results: Amongst a total of 123 patients, control group consisted of 98 (79.7%) patients who received standard post-tPA care in an ICU, and the study group consisted of 25 (20.3%) patients who received standard post-tPA care in Stroke Unit. There were no statistically significant differences between the 2 groups in terms of median LOS or median 90-day NIHSS. However, the median 90-day mRS was lower in the study group compared to the ICU group (0 IQR (0-1) vs. 2 (1-5); P=0.0011). The 90-day death outcome was also lower in the study group compared to the control (0% vs. 25.5%, P