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Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models.
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.
  • Romoli M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.
  • Eusebi P; Neurology and Stroke Unit, Department of Neuroscience, "Maurizio Bufalini" Hospital, Cesena, Italy.
  • Forlivesi S; Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.
  • Gentile M; Public Health Authority, Regione Umbria, Perugia, Italy.
  • Giammello F; IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.
  • Piccolo L; IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.
  • Giannandrea D; International PhD in Translational Molecular Medicine and Surgery, Department of BIOMORF - University of Messina, Messina, Italy.
  • Vidale S; IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.
  • Longoni M; Neurologia e Stroke Unit, Ospedale di Gubbio e Gualdo Tadino, Perugia, Italy.
  • Paolucci M; Neurology Unit, Rimini "Infermi" Hospital, AUSL Romagna, Rimini, Italy.
  • Hsiao J; Neurology and Stroke Unit, Department of Neuroscience, "Maurizio Bufalini" Hospital, Cesena, Italy.
  • Sayles E; Neurology and Stroke Unit, Department of Neuroscience, "Maurizio Bufalini" Hospital, Cesena, Italy.
  • Yeo LL; Department of Neurology, University of Cincinnati, USA.
  • Kristoffersen ES; Department of Neurology, University of Cincinnati, USA.
  • Chamorro A; Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
  • Jiao L; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Khatri P; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
  • Tsivgoulis G; Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.
  • Paciaroni M; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Zini A; "August Pi i Sunyer" Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Int J Stroke ; 16(7): 771-783, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1374086
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombolytic Therapy / Stroke / COVID-19 / Hospitalization Type of study: Clinical Practice Guide / Incidence study / Prognostic study / Randomized controlled trials / Reviews / Systematic review Limits: Humans Language: English Journal: Int J Stroke Year: 2021 Document Type: Article Affiliation country: 17474930211041202

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombolytic Therapy / Stroke / COVID-19 / Hospitalization Type of study: Clinical Practice Guide / Incidence study / Prognostic study / Randomized controlled trials / Reviews / Systematic review Limits: Humans Language: English Journal: Int J Stroke Year: 2021 Document Type: Article Affiliation country: 17474930211041202