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Showing content from https://pubmed.ncbi.nlm.nih.gov/36931673/ below:

Association of the COVID-19 pandemic on stroke admissions and treatment globally: a systematic review

. 2023 Mar 17;13(3):e062734. doi: 10.1136/bmjopen-2022-062734. Association of the COVID-19 pandemic on stroke admissions and treatment globally: a systematic review

Affiliations

¹ Global Health, McMaster University, Hamilton, Ontario, Canada.
² Physical and environmenal science, University of Toronto, Toronto, Ontario, Canada.
³ Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.
⁴ School of Pharmacy, University of Birmingham, Birmingham, UK V.Paudyal@bham.ac.uk.
⁵ Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁶ Faculty Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
⁷ Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ Nexus Institute of Research and Innovation, Lalitpur, Nepal.

PMID: 36931673
PMCID: PMC10030289
DOI: 10.1136/bmjopen-2022-062734

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Association of the COVID-19 pandemic on stroke admissions and treatment globally: a systematic review

Rachel A Van Dusen et al. BMJ Open. 2023.

. 2023 Mar 17;13(3):e062734. doi: 10.1136/bmjopen-2022-062734. Affiliations

¹ Global Health, McMaster University, Hamilton, Ontario, Canada.
² Physical and environmenal science, University of Toronto, Toronto, Ontario, Canada.
³ Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.
⁴ School of Pharmacy, University of Birmingham, Birmingham, UK V.Paudyal@bham.ac.uk.
⁵ Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁶ Faculty Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
⁷ Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ Nexus Institute of Research and Innovation, Lalitpur, Nepal.

PMID: 36931673
PMCID: PMC10030289
DOI: 10.1136/bmjopen-2022-062734

Item in Clipboard

Abstract

Objectives: The COVID-19 pandemic has highlighted insufficiencies and gaps within healthcare systems globally. In most countries, including high-income countries, healthcare facilities were over-run and occupied with too few resources beyond capacity. We carried out a systematic review with a primary aim to identify the influence of the COVID-19 pandemic on the presentation and treatment of stroke globally in populations≥65 years of age.

Design: A systematic review was completed. In total, 38 papers were included following full-text screening.

Data sources: PubMed, MEDLINE and Embase.

Eligibility criteria: Eligible studies included observational and real-world evidence publications with a population who have experienced stroke treatment during the COVID-19 pandemic. Exclusion criteria included studies comparing the effect of the COVID-19 infection on stroke treatment and outcomes.

Data extraction and synthesis: Primary outcome measures extracted were the number of admissions, treatment times and patient outcome. Secondary outcomes were severity on admission, population risk factors and destination on discharge. No meta-analysis was performed.

Results: This review demonstrated that 84% of studies reported decreased admissions rates during the COVID-19 pandemic. However, among those admitted, on average, had higher severity of stroke. Additionally, in-hospital stroke treatment pathways were affected by the implementation of COVID-19 protocols, which resulted in increased treatment times in 60% of studies and increased in-hospital mortality in 82% of studies by 100% on average. The prevalence of stroke subtype (ischaemic or haemorrhagic) and primary treatment methods (thrombectomy or thrombolysis) did not vary due to the COVID-19 pandemic.

Conclusions: During the COVID-19 pandemic, many populations hesitated to seek medical attention, decreasing hospital admissions for less severe strokes and increasing hospitalisation of more severe cases and mortality. The effect of the pandemic on society and healthcare systems needs to be addressed to improve stroke treatment pathways and prepare for potential future epidemics.

Prospero registration number: CRD42021248564.

Keywords: COVID-19; EPIDEMIOLOGY; GERIATRIC MEDICINE; Stroke; Stroke medicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures
Figure 1

Schematic breakdown of systematic review…

Figure 1

Schematic breakdown of systematic review study inclusion and exclusion process. Overall, 3 databases…

Figure 1

Schematic breakdown of systematic review study inclusion and exclusion process. Overall, 3 databases were used with the same search query, which resulted in a total of 576 papers. A total of 300 duplicates were removed, leaving 256 articles for the title and abstract review. Lastly, a full paper review resulted in a final inclusion of 38 studies.

Figure 2

Characteristics of included studies. (A)…

Figure 2

Characteristics of included studies. (A) The breakdown of the economic status of included…

Figure 2

Characteristics of included studies. (A) The breakdown of the economic status of included studies as high-income country, upper-middle-income country or lower-middle-income country as classified by World Bank data. (B) The regional breakdown of included studies by continent. (C) The country breakdown of the Europe region.

Figure 3

The difference in admission rates…

Figure 3

The difference in admission rates and stroke severity between pre-COVID-19 and COVID-19 groups.…

Figure 3

The difference in admission rates and stroke severity between pre-COVID-19 and COVID-19 groups. (A) The difference in the average number of stroke admissions per month between the pre-COVID-19 and COVID-19 groups. One outlier was removed, Rinkel et al, whose admissions rates greatly exceeded the rest. All data can be found in online supplemental appendix table 3. Admission rates were generally lower in the COVID-19 cohort than in the pre-COVID-19 cohort. (B) The difference in stroke severity on hospital admission between the pre-COVID-19 and COVID-19 groups was reported by average NIHSS Score. The average NIHSS Score was greater in the COVID-19 cohort compared with pre-COVID-19 for most studies.

Figure 4

Difference in stroke treatment between…

Figure 4

Difference in stroke treatment between pre-COVID-19 and COVID-19 groups. The difference in stroke…

Figure 4

Difference in stroke treatment between pre-COVID-19 and COVID-19 groups. The difference in stroke treatment of either thrombolysis or thrombectomy was reported as a difference in percentage of patients receiving each treatment within each population cohort. The type of treatment received by patients did not greatly vary between pre-COVID-19 and COVID-19 cohorts, although several studies report an increase in thrombectomies in the COVID-19 group.

Figure 5

In-hospital treatment times. (A) Stroke…

Figure 5

In-hospital treatment times. (A) Stroke pathway treatment times (door-to-needle time), (B) door-to-head CT…

Figure 5

In-hospital treatment times. (A) Stroke pathway treatment times (door-to-needle time), (B) door-to-head CT time, (C) door-to-groin puncture time were reported in minutes in both pre-COVID-19 and COVID-19 cohorts. Treatment times generally increased in the majority of studies in the COVID-19 cohort compared with the pre-COVID-19 group.

Figure 6

Length of stay and mortality…

Figure 6

Length of stay and mortality rate. (A) The average length of stay in…

Figure 6

Length of stay and mortality rate. (A) The average length of stay in the hospital of admitted patients who had a stroke was reported as days in both pre-COVID-19 and COVID-19 cohorts. The length of stay did not vary greatly between the pre-COVID-19 and COVID-19 cohorts; however, some reported a decrease in the average length of hospital stay in the COVID-19 group. (B) In-hospital mortality was reported as a percentage of each population cohort in both pre-COVID-19 and COVID-19 groups. The in-hospital mortality generally increased in the COVID-19 group compared with pre-COVID-19.