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

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• The impact of the COVID-19 pandemic on stroke care networks, specifically comparing drip-and-ship and mothership models, remains unclear.
• Understanding these effects is crucial for optimizing stroke treatment protocols during public health crises.

Purpose of the Study:

• To systematically review and meta-analyze changes in stroke admissions, reperfusion treatment rates, and timing during the first wave of the COVID-19 pandemic compared to pre-pandemic periods.
• To evaluate these changes based on the stroke network model (mothership vs. drip-and-ship).

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA and MOOSE guidelines.
• Searched MEDLINE, EMBASE, and CENTRAL databases for relevant studies up to October 9, 2020.
• Pooled data using random-effects models to compare outcomes between COVID-19 and control periods, stratified by network model.

Main Results:

• A significant reduction in stroke admission rates during the COVID-19 pandemic (IRR=0.69).
• Increased relative presentation of large vessel occlusion and higher rates of endovascular treatment.
• Overall decrease in intravenous thrombolysis, but preserved rates in the mothership model.
• Increased onset-to-door time for drip-and-ship, but door-to-needle and door-to-groin times remained similar.

Conclusions:

• Despite reduced admissions, reperfusion rates and treatment timing were not inferior during the pandemic.
• The mothership model demonstrated resilience, maintaining pre-pandemic standards for intravenous thrombolysis and onset-to-door times.