Effects of the COVID-19 pandemic on stroke response times: a systematic review and meta-analysis

Abstract

ObjectivesCOVID-19 presents a risk for delays to stroke treatment. We examined how COVID-19 affected stroke response times.MethodsA literature search was conducted to identify articles covering stroke during COVID-19 that included time metrics data pre- and post-pandemic. For each outcome, pooled relative change from baseline and 95% CI were calculated using random-effects models. Heterogeneity was explored through subgroup analyses comparing comprehensive stroke centers (CSCs) to non-CSCs.Results38 included studies reported on 6109 patients during COVID-19 and 14 637 patients during the pre-COVID period. Pooled increases of 20.9% (95% CI 5.8% to 36.1%) in last-known-well (LKW) to arrival times, 1.2% (−2.9% to 5.3%) in door-to-imaging (DTI), 0.8% (–2.9% to 4.5%) in door-to-needle (DTN), 2.8% (−5.0% to 10.6%) in door-to-groin (DTG), and 19.7% (11.1% to 28.2%) in door-to-reperfusion (DTR) times were observed during COVID-19. At CSCs, LKW increased by 24.0% (−0.3% to 48.2%), DTI increased by 1.6% (−3.0% to 6.1%), DTN increased by 3.6% (1.2% to 6.0%), DTG increased by 4.6% (−5.9% to 15.1%), and DTR increased by 21.2% (12.3% to 30.1%). At non-CSCs, LKW increased by 12.4% (−1.0% to 25.7%), DTI increased by 0.2% (−2.0% to 2.4%), DTN decreased by −4.6% (−11.9% to 2.7%), DTG decreased by −0.6% (−8.3% to 7.1%), and DTR increased by 0.5% (−31.0% to 32.0%). The increases during COVID-19 in LKW (p=0.01) and DTR (p=0.00) were statistically significant, as was the difference in DTN delays between CSCs and non-CSCs (p=0.04).ConclusionsFactors during COVID-19 resulted in significantly delayed LKW and DTR, and mild delays in DTI, DTN, and DTG. CSCs experience more pronounced delays than non-CSCs.

Impact of in-hospital COVID-19 quarantine policy changes on quality of acute stroke care: A single center experience

“…16 Regarding stroke patients, a meta-analysis has shown that the onset-to-arrival time of stroke patients is increased during the COVID-19 era because of a tendency to avoid hospital visits. 17 Likewise, our study showed that the number of acute stroke patients decreased as the pandemic went on, which could be attributed to reluctance of patients to seek hospital care. The previously mentioned meta-analysis also highlighted that stroke response time was delayed within hospitals due to precautions such as symptom screening and additional isolation policies.…”

“…The previously mentioned meta-analysis also highlighted that stroke response time was delayed within hospitals due to precautions such as symptom screening and additional isolation policies. 17 Strict in-hospital isolation policies can also impact the management of acute ischemic stroke, leading to increased severity and in-hospital mortality rates. 5 These not only affects acute stroke patients, but also has repercussions on general stroke patient care, including response times, treatment interventions, and stroke prevention, all of which are deteriorated after the onset of COVID-19.…”

“…5 These not only affects acute stroke patients, but also has repercussions on general stroke patient care, including response times, treatment interventions, and stroke prevention, all of which are deteriorated after the onset of COVID-19. [17][18][19] These ndings emphasize the need for a cautious approach when settling a policy regarding infection control to ensure it does not disrupt the process for acute stroke care.…”

Neurological consequences of COVID-19

“…Severe coronavirus infection was reported in 3.3% (1722 out of 52,026) of all stroke-related admissions. Most authors emphasise that the COVID-19 pandemic was associated with a global decrease in stroke-related hospitalisations and rarer thrombolytic treatment or mechanical thrombectomy [105][106][107][108][109].…”

Getting ahead of stroke

“…Stroke literacy and trust in the healthcare system have been cited as important factors 12. The ongoing COVID-19 pandemic has further highlighted the criticality of endovascular stroke care and the educational needs for the community 13–16…”