Meta-analysis/systematic review (Red)
The effect of the COVID pandemic on stroke networks performance are unclear, particularly with consideration of drip&ship versus mothership models. In this article the authors systematically reviewed and meta-analyzed variations in stroke admissions, rate and timing of reperfusion treatments during the 1st-wave COVID pandemic versus the pre-pandemic timeframe depending on stroke network model adopted. The systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. The authors searched MEDLINE, EMBASE and CENTRAL until 9/10/2020, for studies reporting variations in ischemic stroke admissions, treatment rates and timing in COVID (1st 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 D&S model. Overall, twenty-nine studies were included in quantitative synthesis (n= 212960). 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 (RR=1.62,95%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 minutes,95%CI=0-64). Door-to-scan was longer in COVID-period (+5 minutes,95%CI=2-7). Door-to-needle and door-to-groin were similar in COVID and control period. The authors concluded that despite a 35% drop in stroke admissions during the 1st 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.
Romoli M, Eusebi P, Forlivesi S, Gentile M, Giammello F, Piccolo L, Giannandrea D, Vidale S, Longoni M, Paolucci M, Hsiao J, Sayles E, Yeo L, Kristoffersen ES, Chamorro ÃN, Jiao L, Khatri P, Tsivgoulis G, Paciaroni M, Zini A. EXPRESS: Stroke network performance during the first COVID-19 pandemic stage: a meta-analysis based on stroke network models. Int J Stroke. 2021 Aug 24:17474930211041202. doi: 10.1177/17474930211041202.