Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults with Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis

Burton, Edel; Aladkhen, Johnny; O’Donnell, Cathal; Masterson, Siobhán; Merwick, Áine; McCarthy, Vera J. C.; Kearney, Patricia M.; Buckley, Claire

doi:10.1080/10903127.2023.2219729

Cited by 2 publications

(3 citation statements)

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“… 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. Also, current studies are mainly descriptive in nature, with the minority of studies carrying out analyses that adjusts for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

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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

Burton,

Quinn,

Crosbie-Staunton

et al. 2024

BMJ Open

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ObjectivesTime is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021.DesignWe conducted a secondary data analysis with a quasi-experimental design.SettingWe used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as ‘1 March 2020–31 December 2021’ and the pre-COVID-19 period ‘1 January 2018–29 February 2020’.Primary and secondary outcome measuresWe compared five ambulance time intervals: ‘allocation performance’, ‘mobilisation performance’, ‘response time’, ‘on scene time’ and ‘conveyance time’ between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis.ParticipantsWe included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021.Results40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001).ConclusionsA ’shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.

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Section: Discussionmentioning

confidence: 99%

“…Also, current studies are mainly descriptive in nature, with the minority of studies carrying out analyses that adjusts for potential confounders. 67 …”

Section: Discussionmentioning

confidence: 99%

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

Burton,

Quinn,

Crosbie-Staunton

et al. 2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a study of patients with ischemic stroke, Velasco et al reported prolonged time from ambulance dispatch to hospital arrival during the pandemic period ( 20 ). Furthermore, a systemic review of prehospital care for patients with suspected stroke or transient ischemic attack (TIA) revealed that transport delay for patients with suspected stroke or TIA increased during the COVID-19 pandemic ( 21 ). In contrast, a systemic review of severe trauma during the restriction policy period in the first wave of the COVID-19 pandemic reported that the number of severe trauma patients decreased during this wave of the COVID-19 pandemic, but severity and mortality remained the same ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with difficulty in hospital acceptance during the COVID-19 pandemic period in Osaka Prefecture, Japan: a population-based study

Katayama,

Tanaka,

Nakao

et al. 2024

Front. Public Health

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BackgroundIn many countries, emergency medical systems were responsible for initial treatment of patients with COVID-19. Generally, acceptance by medical institutions may not be sufficient, and it may take much time to determine the medical institution to which to transport the patient. This problem is termed “difficulty in hospital acceptance (DIH),” and it is used as a key performance indicator in the assessment of the EMS in Japan. The purpose of this study was to reveal the factors associated with the DIH during the COVID-19 pandemic using dataset in the ORION (Osaka emergency information Research Intelligent Operation Network system).MethodsThis was a retrospective descriptive study with a 3-year study period from January 1, 2019 to December 31, 2021. We included patients who were recorded in the ORION system during the study period. The primary endpoint was defined as DIH. Multivariable logistic regression model was used to assess factors associated with DIH during the COVID-19 pandemic and calculated their adjusted odds ratio (AOR) and associated 95% confidence interval (CI).Results1,078,850 patients included in this study. Of them, 41,140 patients (3.8%) experienced DIH and 1,037,710 patients (96.2%) did not experience DIH. The median age was 71 years (IQR: 45–82), and 543,760 patients (50.4%) were male. In this study, SpO2, body temperature, and epidemic period of COVID-19 were associated with difficulty in hospital acceptance. The highest AOR of SpO2 was 80% or less (AOR: 1.636, [95% CI: 1.532–1.748]), followed by 81–85% (AOR: 1.584, [95% CI: 1.459–1.721]). The highest AOR of body temperature was 38.0–38.9°C (AOR: 1.969 [95% CI: 1.897–2.043]), followed by 39°C or higher (AOR: 1.912 [95% CI: 1.829–1.998]). The highest AOR of epidemic period of COVID-19 was the 4th wave (AOR: 2.134, [95% CI: 2.065–2.205]), followed by the 3rd wave (AOR: 1.842, [95% CI: 1.785–1.901]).ConclusionIn this study, we revealed factors associated with the DIH during the COVID-19 pandemic. As various factors are involved in the spread of an unknown infectious disease, it is necessary not only to plan in advance but also to take appropriate measures according to the situation in order to smoothly accept emergency patients.

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Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults with Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis

Cited by 2 publications

References 82 publications

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

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

Factors associated with difficulty in hospital acceptance during the COVID-19 pandemic period in Osaka Prefecture, Japan: a population-based study

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