Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis

Abstract

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.

Stretcher Angles: Impact on Vital Signs and Optic Nerve Sheath Diameter in Prehospital Stroke Patients

“…In the study conducted by Burton et al, the time spent in EMS was found to be approximately 26.5 minutes (13). In the study conducted by Vuorinen et al, the time spent in EMS was found to be 99 minutes (14).…”

Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study

“…Due to the time-sensitivity of acute stroke/TIA management and treatment any delay in the stroke chain of survival could lead to worse clinical and functional outcomes. Other studies have also reported changes in demographic characteristics of those presenting with stroke/TIA during the COVID-19 pandemic,62 85 86 whereas further studies found no change in demographics, between the two periods 57 67 87…”

“…Whereas other international studies found an increase in suspected stroke/TIA call volume during the period 65 66. At the time of writing, literature in acute stroke care during the COVID-19 pandemic was primarily focused on single centre studies set in hospitals, with a lack of papers focusing on the prehospital response 67. Available prehospital papers focus on either one or more early waves of the COVID-19 pandemic,62 67 and do not investigate emerging patterns over multiple waves.…”

“…At the time of writing, literature in acute stroke care during the COVID-19 pandemic was primarily focused on single centre studies set in hospitals, with a lack of papers focusing on the prehospital response 67. Available prehospital papers focus on either one or more early waves of the COVID-19 pandemic,62 67 and do not investigate emerging patterns over multiple waves. Also, current studies are mainly descriptive in nature, with the minority of studies carrying out analyses that adjusts for potential confounders 67…”

“…Available prehospital papers focus on either one or more early waves of the COVID-19 pandemic,62 67 and do not investigate emerging patterns over multiple waves. Also, current studies are mainly descriptive in nature, with the minority of studies carrying out analyses that adjusts for potential confounders 67…”