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

IntroductionCOVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischaemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions.ObjectivesTo synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA.MethodsFollowing a published protocol, we conducted a systematic search of six databases up to 31 May 2022. We re-ran this search on 14 April 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance times (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review.ResultsOf 4083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 minutes (-2.19 to -0.38)) and mean total prehospital interval (-6.42 minutes (-10.60 to -2.25)) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 (0.02 to 0.33)). Ambulance response interval definitions and terminology varied between regions and countries.ConclusionsOur review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimise delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.