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Title: Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models
Authors: Romoli, Michele
Eusebi, Paolo
Forlivesi, Stefano
Gentile, Mauro
Giammello, Fabrizio
Piccolo, Laura
Giannandrea, David
Vidale, Simone
Longoni, Marco
Paolucci, Matteo
Hsiao, Jessica
Sayles, Emily
Yeo, Leonard LL 
Kristoffersen, Espen Saxhaug
Chamorro, Angel
Jiao, Liqun
Khatri, Pooja
Tsivgoulis, Georgios
Paciaroni, Maurizio
Zini, Andrea
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Peripheral Vascular Disease
Neurosciences & Neurology
Cardiovascular System & Cardiology
drip and ship
stroke network
Issue Date: 28-Aug-2021
Citation: Romoli, Michele, Eusebi, Paolo, Forlivesi, Stefano, Gentile, Mauro, Giammello, Fabrizio, Piccolo, Laura, Giannandrea, David, Vidale, Simone, Longoni, Marco, Paolucci, Matteo, Hsiao, Jessica, Sayles, Emily, Yeo, Leonard LL, Kristoffersen, Espen Saxhaug, Chamorro, Angel, Jiao, Liqun, Khatri, Pooja, Tsivgoulis, Georgios, Paciaroni, Maurizio, Zini, Andrea (2021-08-28). Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models. INTERNATIONAL JOURNAL OF STROKE 16 (7) : 771-783. ScholarBank@NUS Repository.
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.
ISSN: 17474930
DOI: 10.1177/17474930211041202
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