Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Reports indicated a decline in emergency medical presentations, including stroke, during the COVID-19 pandemic.
• The pandemic's impact on stroke incidence and treatment rates required thorough investigation.

Purpose of the Study:

• To conduct a meta-analysis assessing the effect of the COVID-19 pandemic on stroke presentation rates.
• To evaluate the pandemic's influence on the administration of reperfusion therapies for stroke.

Main Methods:

• Systematic literature search following MOOSE guidelines for observational studies.
• Meta-analysis of aggregated data using random-effect models to compare pre-pandemic and pandemic periods.
• Inclusion of 37 observational studies with a total of 375,657 participants.

Main Results:

• A significant decline in all stroke types was observed during the pandemic: overall stroke (26.0%), ischemic (25.3%), hemorrhagic (27.6%), transient ischemic attacks (41.9%), and stroke mimics (45.6%).
• The reduction in stroke presentations was more pronounced for mild symptoms compared to moderate/severe cases.
• While rates of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) decreased, the likelihood of receiving these treatments did not significantly change between periods.

Conclusions:

• Stroke incidence rates, encompassing all subtypes, markedly decreased during the COVID-19 pandemic.
• Emphasizing the critical need for public awareness to seek immediate medical attention for stroke symptoms during pandemics.
• Further research is necessary to determine the long-term effects of delayed secondary prevention initiation on stroke outcomes.