Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate.  Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.

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Introduction:The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions, like stroke and transient ischaemic attack (TIA). Thus, the aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA.Method:Following a published study protocol, a systematic search of databases was conducted up to May 31, 2022. Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic were considered for inclusion. The methodological quality of the included studies was assessed using the appropriate Joanna Briggs Institute tool. Overall pooled estimates of ambulance times (activation, response, patient care time) were calculated. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Stroke/TIA emergency call volume was reported using a narrative synthesis. Clinical stakeholders and Patient and Public Involvement Contributors were involved from research question development to dissemination of results.Results:Of 4083 studies identified, 56 unique articles met the inclusion criteria. Early data from 8/12 studies reporting ambulance times, suggests that patient care time increased. Furthermore, emergency call volume for stroke/TIA decreased during the COVID-19 pandemic, according to 43/56 studies that reported this outcome. Terminology for ambulance time intervals differed between studies. The majority of studies reported time from call to hospital arrival, whereas the minority of studies reported activation time.Conclusion:Preliminary results from our systematic review and meta-analysis show that conflicting evidence exists on the impact of the COVID-19 pandemic on ambulance times and emergency call volume for stroke/TIA. Thus, this review synthesized available evidence on the varied effects across different countries, healthcare systems and ambulance time terminology. Review findings may inform our understanding of healthcare system resilience in response to crises on a broader level.