Abstract
BackgroundThe effect of the COVID pandemic on stroke network performance is unclear, particularly with consideration of drip&ship vs. mothership models.AimsWe systematically reviewed and meta-analyzed variations in stroke admissions, rate and timing of reperfusion treatments during the first wave COVID pandemic vs. the pre-pandemic timeframe depending on stroke network model adopted.Summary of findingsThe systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We searched MEDLINE, EMBASE, and CENTRAL until 9 October 2020 for studies reporting variations in ischemic stroke admissions, treatment rates, and timing in COVID (first wave) vs. control-period. Primary outcome was the weekly admission incidence rate ratio (IRR = admissions during COVID-period/admissions during control-period). Secondary outcomes were (i) changes in rate of reperfusion treatments and (ii) time metrics for pre- and in-hospital phase. Data were pooled using random-effects models, comparing mothership vs. drip&ship model. Overall, 29 studies were included in quantitative synthesis (n = 212,960). COVID-period was associated with a significant reduction in stroke admission rates (IRR = 0.69, 95%CI = 0.61–0.79), with higher relative presentation of large vessel occlusion (risk ratio (RR) = 1.62, 95% confidence interval (CI) = 1.24–2.12). Proportions of patients treated with endovascular treatment increased (RR = 1.14, 95%CI = 1.02–1.28). Intravenous thrombolysis decreased overall (IRR = 0.72, 95%CI = 0.54–0.96) but not in the mothership model (IRR = 0.81, 95%CI = 0.43–1.52). Onset-to-door time was longer for the drip&ship in COVID-period compared to the control-period (+32 min, 95%CI = 0–64). Door-to-scan was longer in COVID-period (+5 min, 95%CI = 2–7). Door-to-needle and door-to-groin were similar in COVID-period and control-period.ConclusionsDespite a 35% drop in stroke admissions during the first pandemic wave, proportions of patients receiving reperfusion and time-metrics were not inferior to control-period. Mothership preserved the weekly rate of intravenous thrombolysis and the onset-to-door timing to pre-pandemic standards.
Highlights
Stroke care is based on fast rescue, rapid assessment, quick transportation according to local stroke network model and standardized management.[1,2] Rapid definition of stroke syndromes and reperfusion of salvageable tissue is mandatory to increase chances of living in functional independence later in life.[1,2,3]In December 2019, the emergence of the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), in China, gradually evolved into a pandemic, with the death toll steadily increasing
Mothership preserved the weekly rate of intravenous thrombolysis and the onset-to-door timing to pre-pandemic standards
COVIDperiod varied according to the spread of the pandemic, starting from January in studies performed in eastern countries,[21,22] March in European countries,[4,23] and up to May in western countries[24,25,26] (Table 1)
Summary
Stroke care is based on fast rescue, rapid assessment, quick transportation according to local stroke network model and standardized management.[1,2] Rapid definition of stroke syndromes and reperfusion of salvageable tissue is mandatory to increase chances of living in functional independence later in life.[1,2,3]In December 2019, the emergence of the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), in China, gradually evolved into a pandemic, with the death toll steadily increasing. Stroke care is based on fast rescue, rapid assessment, quick transportation according to local stroke network model and standardized management.[1,2] Rapid definition of stroke syndromes and reperfusion of salvageable tissue is mandatory to increase chances of living in functional independence later in life.[1,2,3]. The outbreak has forced national and local authorities to adapt emergency services to the need of the hour, and to impose global and unprecedented restrictions, from social distancing to national lockdown. The impact of such regulations on people perception of health problems and on their seeking of medical care has yet to be fully understood. The effect of the COVID pandemic on stroke network performance is unclear, with consideration of drip&ship vs. mothership models
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