机构：[1]IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, ‘‘C.A. Pizzardi’’ Maggiore Hospital, Bologna, Italy[2]Neurology and Stroke Unit, Department of Neuroscience, ‘‘Maurizio Bufalini’’ Hospital, Cesena, Italy[3]Neurology Clinic, University of Perugia – S. Maria della Misericordia Hospital, Perugia, Italy[4]Public Health Authority, Regione Umbria, Perugia, Italy[5]International PhD in Translational Molecular Medicine and Surgery, Department of BIOMORF – University of Messina, Messina, Italy[6]Neurologia e Stroke Unit, Ospedale di Gubbio e Gualdo Tadino, Perugia, Italy[7]Neurology Unit, Rimini ‘‘Infermi’’ Hospital, AUSL Romagna, Rimini, Italy[8]Department of Neurology, University of Cincinnati, USA[9]Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore[10]Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore[11]Department of Neurology, Akershus University Hospital, Lørenskog, Norway[12]Department of General Practice, HELSAM, University of Oslo, Oslo, Norway[13]Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain[14]‘‘August Pi i Sunyer’’ Biomedical Research Institute (IDIBAPS), Barcelona, Spain[15]Department of Neurosurgery, Xuanwu Hospital, Beijing, China神经科系统神经外科首都医科大学宣武医院[16]Department of Neurology, University of Tennessee Health Science Center, Memphis, USA[17]Second Department of Neurology, ‘‘Attikon’’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece[18]Neurology – Stroke Unit, Ospedale San Giuseppe, IRCCS MultiMedica, Milano, Italy
BackgroundThe effect of the COVID pandemic on stroke networks performance are unclear, particularly with consideration of drip&ship versus mothership models. AimsWe systematically reviewed and meta-analyzed variations in stroke admissions, rate and timing of reperfusion treatments during the 1st-wave COVID pandemic versus the pre-pandemic timeframe depending on stroke network model adopted.Summary of findingsThe systematic review followed registered protocol (PROSPERO-CRD42020211535), PRISMA and MOOSE guidelines. We searched MEDLINE, EMBASE and CENTRAL until 9/10/2020, for studies reporting variations in ischemic stroke admissions, treatment rates and timing in COVID (1st 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 D&S model. Overall, twenty-nine studies were included in quantitative synthesis (n= 212960). 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 (RR=1.62,95%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 minutes,95%CI=0-64). Door-to-scan was longer in COVID-period (+5 minutes,95%CI=2-7). Door-to-needle and door-to-groin were similar in COVID and control period.ConclusionsDespite a 35% drop in stroke admissions during the 1st 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.
第一作者机构：[1]IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, ‘‘C.A. Pizzardi’’ Maggiore Hospital, Bologna, Italy[2]Neurology and Stroke Unit, Department of Neuroscience, ‘‘Maurizio Bufalini’’ Hospital, Cesena, Italy[3]Neurology Clinic, University of Perugia – S. Maria della Misericordia Hospital, Perugia, Italy[*1]Neurology and Stroke Unit, Department of Neuroscience, ‘‘Maurizio Bufalini’’ Hospital, Viale Ghirotti 286, Cesena, Italy.
通讯作者：
通讯机构：[1]IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, ‘‘C.A. Pizzardi’’ Maggiore Hospital, Bologna, Italy[2]Neurology and Stroke Unit, Department of Neuroscience, ‘‘Maurizio Bufalini’’ Hospital, Cesena, Italy[3]Neurology Clinic, University of Perugia – S. Maria della Misericordia Hospital, Perugia, Italy[*1]Neurology and Stroke Unit, Department of Neuroscience, ‘‘Maurizio Bufalini’’ Hospital, Viale Ghirotti 286, Cesena, Italy.
推荐引用方式(GB/T 7714)：
Michele Romoli,Paolo Eusebi,Stefano Forlivesi,et al.EXPRESS: Stroke network performance during the first COVID-19 pandemic stage: a meta-analysis based on stroke network models.[J].INTERNATIONAL JOURNAL OF STROKE.2021,16(7):771-783.doi:10.1177/17474930211041202.
APA：
Michele Romoli,Paolo Eusebi,Stefano Forlivesi,Mauro Gentile,Fabrizio Giammello...&Andrea Zini.(2021).EXPRESS: Stroke network performance during the first COVID-19 pandemic stage: a meta-analysis based on stroke network models..INTERNATIONAL JOURNAL OF STROKE,16,(7)
MLA：
Michele Romoli,et al."EXPRESS: Stroke network performance during the first COVID-19 pandemic stage: a meta-analysis based on stroke network models.".INTERNATIONAL JOURNAL OF STROKE 16..7(2021):771-783
