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Meta-Analysis
. 2021 Dec 14;11(12):e050559.
doi: 10.1136/bmjopen-2021-050559.

Impact of COVID-19 pandemic on haemorrhagic stroke admissions: a systematic review and meta-analysis

Yijie You  1 , Yunlian Niu  2 , Fengbing Sun  3 , Jian Zhang  3 , Sheng Huang  3 , Peiyuan Ding  1 , Xuhui Wang  4
Affiliations
Meta-Analysis

Impact of COVID-19 pandemic on haemorrhagic stroke admissions: a systematic review and meta-analysis

Yijie You et al. BMJ Open. .

Abstract

Background and purpose: COVID-19 pandemic, a global health crisis, is disrupting the present medical environment. This systematic review and meta-analysis aimed to evaluate the impact of the COVID-19 pandemic on stroke hospitalisations, especially haemorrhagic stroke.

Methods: The EMBASE, PubMed, Web of Science, Elsevier, Medline, Cochrane Library and Google Scholar electronic databases were searched for all relevant studies. Two researchers independently screened the studies, extracted data and assessed the quality of the included studies. Odds ratio (OR), total events, OR and 95% CI were considered as the effect size. A fixed-effects model was used to pool the study-specific estimate. The present study was performed by using Review Manager (V.5.3.0) software. We assessed the risk of bias using the Newcastle-Ottawa Scale.

Results: A total of 17 studies with 14 445 cases were included. Overall, the number of stroke admissions is lower in the pandemic period versus the control period (6252 vs 8193). The difference of haemorrhagic stroke is significant, with 1233 of 6252 cases in the pandemic group and 1621 of 8193 cases in the control group. Intracerebral haemorrhage is present in 461 of 1948 cases in the pandemic group and 618 of 2734 cases in the control group. As for subarachnoid haemorrhage, the difference between the two groups is significant, with 70 of 985 cases in the pandemic group and 202 of 1493 cases in the control group.

Conclusions: The number of stroke admissions is lower in the pandemic period compared with the control period. There is a higher rate of haemorrhagic stroke in the pandemic period. Subgroup analysis identifies a significant increase in the occurrence of intracerebral haemorrhage in the pandemic period. Due to limited data and the impact of a single article, the impact of COVID-19 pandemic on subarachnoid haemorrhage is unclear.

Keywords: COVID-19; neurology; neurosurgery; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of study selection process.
Figure 2
Figure 2
(A) Forest plot showing the HS admission during the pandemic compared with the control period. (B) Forest plot showing the ICH admission during the pandemic compared with the control period. (C) Forest plot showing the SAH admission during the pandemic compared with the control period. HS, haemorrhagic stroke; ICH, intracerebral haemorrhage; SAH, subarachnoid haemorrhage.
Figure 3
Figure 3
Funnel plot with the pooled estimate of the fixed-effects model. (A) The funnel plot of HS group. (B) The funnel plot of ICH group. HS, haemorrhagic stroke; ICH, intracerebral haemorrhage
See this image and copyright information in PMC

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