Background

The effect of the COVID pandemic on stroke networks performance are unclear, particularly with consideration of drip&ship versus mothership models.

Aims

We 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.

Summary of findings

The systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We 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.

Conclusions

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.

背景

新冠病毒大流行对中风网络性能的影响尚不清楚，特别是考虑到点滴和运输模型与母船模型。

目标

我们根据所采用的中风网络模型，系统地回顾和荟萃分析了第一波新冠肺炎大流行期间中风入院率、再灌注治疗率和时间与大流行前时间范围的变化。

调查结果摘要

系统评价遵循注册方案 (PROSPERO-CRD42020211535)、PRISMA 和 MOOSE 指南。我们检索了截至 2020 年 9 月 10 日的 MEDLINE、EMBASE 和 CENTRAL，以查找报告新冠肺炎（第一波）与对照期的缺血性卒中入院率、治疗率和时间安排差异的研究。主要结果是每周入院发生率（IRR=新冠肺炎期间入院人数/对照期间入院人数）。次要结果是（i）再灌注治疗率的变化和（ii）院前和院内阶段的时间指标。使用随机效应模型汇总数据，比较 mothership 与 D&S 模型。

总体而言，定量综合中纳入了 29 项研究 (n= 212960)。新冠肺炎期间与卒中入院率显着降低相关（IRR=0.69，95%CI=0.61-0.79），大血管闭塞的相对表现较高（RR=1.62，95%CI=1.24-2.12）。接受血管内治疗的患者比例有所增加（RR=1.14，95%CI=1.02-1.28）。静脉溶栓总体下降（IRR=0.72，95%CI=0.54-0.96），但在母体模型中没有下降（IRR=0.81，95%CI=0.43-1.52）。与对照期相比，COVID 期点滴和运送的起始到送货时间较长（+32 分钟，95%CI=0-64）。新冠肺炎期间上门扫描时间较长（+5 分钟，95%CI=2-7）。在新冠肺炎和控制期间，门到针和门到腹股沟的情况相似。

结论

尽管在第一波大流行期间，中风入院人数下降了 35%，但接受再灌注的患者比例和时间指标并不逊色于对照时期。Mothership 将每周静脉溶栓率和发病到就诊时间保持在大流行前的标准。