Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value=0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value=0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p=0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Out-come Scale (GOS), five variables showed p-values<0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions We documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a “therapeutic delay” and led to results overall comparable to the control period.

Aneurismal subarachnoid hemorrhage during the {COVID}-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Davide Locatelli;Jacopo Carlo Poli;Cesare Zoia;
2021-01-01

Abstract

Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value=0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value=0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p=0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Out-come Scale (GOS), five variables showed p-values<0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions We documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a “therapeutic delay” and led to results overall comparable to the control period.
https://dx.doi.org/10.1007/s00701-021-05013-9
COVID-19; Hub and Spoke; Intracranial bleeding aneurysm; Logistic regression; Pandemic; Subarachnoid hemorrhage
Fiorindi, Alessandro; Vezzoli, Marika; Doglietto, Francesco; Zanin, Luca; Saraceno, Giorgio; Agosti, Edoardo; Barbieri, Antonio; Bellocchi, Silvio; Bernucci, Claudio; Bongetta, Daniele; Cardia, Andrea; Costi, Emanuele; Egidi, Marcello; Fioravanti, Antonio; Gasparotti, Roberto; Giussani, Carlo; Grimod, Gianluca; Latronico, Nicola; Locatelli, Davide; Mardighian, Dikran; Nodari, Giovanni; Poli, JACOPO CARLO; Rasulo, Frank; Roca, Elena; Marco Sicuri, Giovanni; Spena, Giannantonio; Stefini, Roberto; Vivaldi, Oscar; Zoia, Cesare; Calza, Stefano; Maria Fontanella, Marco; Cenzato, Marco
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2118229
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