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

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