Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models

Author:

Romoli Michele123ORCID,Eusebi Paolo4,Forlivesi Stefano1,Gentile Mauro1,Giammello Fabrizio5ORCID,Piccolo Laura1,Giannandrea David6ORCID,Vidale Simone7ORCID,Longoni Marco2,Paolucci Matteo2,Hsiao Jessica8,Sayles Emily8,Yeo Leonard LL910,Kristoffersen Espen Saxhaug1112ORCID,Chamorro Angel1314ORCID,Jiao Liqun15ORCID,Khatri Pooja8,Tsivgoulis Georgios1617ORCID,Paciaroni Maurizio18,Zini Andrea1ORCID

Affiliation:

1. IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center,  “C.A. Pizzardi” Maggiore Hospital, Bologna, Italy

2. Neurology and Stroke Unit, Department of Neuroscience, “Maurizio Bufalini” Hospital, Cesena, Italy

3. Neurology Clinic, University of Perugia – S. Maria della Misericordia Hospital, Perugia, Italy

4. Public Health Authority, Regione Umbria, Perugia, Italy

5. International PhD in Translational Molecular Medicine and Surgery, Department of BIOMORF – University of Messina, Messina, Italy

6. Neurologia e Stroke Unit, Ospedale di Gubbio e Gualdo Tadino, Perugia, Italy

7. Neurology Unit, Rimini “Infermi” Hospital, AUSL Romagna, Rimini, Italy

8. Department of Neurology, University of Cincinnati, USA

9. Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore

10. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

11. Department of Neurology, Akershus University Hospital, Lørenskog, Norway

12. Department of General Practice, HELSAM, University of Oslo, Oslo, Norway

13. Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain

14. “August Pi i Sunyer” Biomedical Research Institute (IDIBAPS), Barcelona, Spain

15. Department of Neurosurgery, Xuanwu Hospital, Beijing, China

16. Department of Neurology, University of Tennessee Health Science Center, Memphis, USA

17. Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

18. Neurology – Stroke Unit, Ospedale San Giuseppe, IRCCS MultiMedica, Milano, Italy

Abstract

Background The effect of the COVID pandemic on stroke network performance is unclear, particularly with consideration of drip&ship vs. mothership models. Aims We 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 findings The 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. Conclusions Despite 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.

Publisher

SAGE Publications

Subject

Neurology

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