Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic.

Journal: Stroke And Vascular Neurology

Published: October 19, 2020

Abstract

Background: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.

Methods: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. Findings: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. Interpretation: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Authors

Thanh Nguyen, Diogo Haussen, Muhammad Qureshi, Hiroshi Yamagami, Toshiyuki Fujinaka, Ossama Mansour, Mohamad Abdalkader, Michael Frankel, Zhongming Qiu, Allan Taylor, Pedro Lylyk, Omer Eker, Laura Mechtouff, Michel Piotin, Fabricio Lima, Francisco Mont'alverne, Wazim Izzath, Nobuyuki Sakai, Mahmoud Mohammaden, Alhamza Al Bayati, Leonardo Renieri, Salvatore Mangiafico, David Ozretic, Vanessa Chalumeau, Saima Ahmad, Umair Rashid, Syed Hussain, Seby John, Emma Griffin, John Thornton, Jose Fiorot, Rodrigo Rivera, Nadia Hammami, Anna Cervantes Arslanian, Hormuzdiyar Dasenbrock, Huynh Vu, Viet Nguyen, Steven Hetts, Romain Bourcier, Romain Guile, Melanie Walker, Malveeka Sharma, Don Frei, Pascal Jabbour, Nabeel Herial, Fawaz Al Mufti, Atilla Ozdemir, Ozlem Aykac, Dheeraj Gandhi, Chandril Chugh, Charles Matouk, Pascale Lavoie, Randall Edgell, Andre Beer Furlan, Michael Chen, Monika Killer Oberpfalzer, Vitor Pereira, Patrick Nicholson, Vikram Huded, Nobuyuki Ohara, Daisuke Watanabe, Dong Shin, Pedro Magalhaes, Raghid Kikano, Santiago Ortega Gutierrez, Mudassir Farooqui, Amal Abou Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena Cora, Rotem Sivan Hoffmann, Roberto Crosa, Markus Möhlenbruch, Simon Nagel, Hosam Al Jehani, Sunil Sheth, Victor Lopez Rivera, James Siegler, Achmad Sani, Ajit Puri, Anna Kuhn, Gianmarco Bernava, Paolo Machi, Daniel Abud, Octavio Pontes Neto, Ajay Wakhloo, Barbara Voetsch, Eytan Raz, Shadi Yaghi, Brijesh Mehta, Naoto Kimura, Mamoru Murakami, Jin Lee, Ji Hong, Robert Fahed, Gregory Walker, Eiji Hagashi, Steve Cordina, Hong Roh, Ken Wong, Juan Arenillas, Mario Martinez Galdamez, Jordi Blasco, Alejandro Rodriguez Vasquez, Luisa Fonseca, M Silva, Teddy Wu, Simon John, Alex Brehm, Marios Psychogios, William Mack, Matthew Tenser, Tatemi Todaka, Miki Fujimura, Roberta Novakovic, Jun Deguchi, Yuri Sugiura, Hiroshi Tokimura, Rakesh Khatri, Michael Kelly, Lissa Peeling, Yuichi Murayama, Hugh Winters, Johnny Wong, Mohamed Teleb, Jeremy Payne, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Masaaki Uno, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Masafumi Morimoto, Junichi Iida, Vasu Saini, Dileep Yavagal, Saif Bushnaq, Wenguo Huang, Italo Linfante, Jawad Kirmani, David Liebeskind, Viktor Szeder, Ruchir Shah, Thomas Devlin, Lee Birnbaum, Jun Luo, Anchalee Churojana, Hesham Masoud, Carlos Lopez, Brendan Steinfort, Alice Ma, Ameer Hassan, Amal Al Hashmi, Mollie Mcdermott, Maxim Mokin, Alex Chebl, Odysseas Kargiotis, Georgios Tsivgoulis, Jane Morris, Clifford Eskey, Jesse Thon, Leticia Rebello, Dorothea Altschul, Oriana Cornett, Varsha Singh, Jeyaraj Pandian, Anirudh Kulkarni, Pablo Lavados, Veronica Olavarria, Kenichi Todo, Yuki Yamamoto, Gisele Silva, Serdar Geyik, Jasmine Johann, Sumeet Multani, Artem Kaliaev, Kazutaka Sonoda, Hiroyuki Hashimoto, Adel Alhazzani, David Chung, Stephan Mayer, Johanna Fifi, Michael Hill, Hao Zhang, Zhengzhou Yuan, Xianjin Shang, Alicia Castonguay, Rishi Gupta, Tudor Jovin, Jean Raymond, Osama Zaidat, Raul Nogueira

Relevant Conditions

Severe Acute Respiratory Syndrome (SARS), Subarachnoid Hemorrhage, COVID-19

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic.

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