Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
Thanh N. Nguyen, Diogo C Haussen, Muhammad M. Qureshi, Hiroshi Yamagami, Toshiyuki Fujinaka, Ossama Y Mansour, Mohamad Abdalkader, Michael Frankel, Zhongming Qiu, Allan Taylor, Pedro Lylyk, Omer Eker, Laura Mechtouff, Michel Piotin, Fabrício Oliveira Lima, Francisco Mont’Alverne, Wazim Izzath, Nobuyuki Sakai, Mahmoud Mohammaden, Alhamza R Al‐Bayati, Leonardo Renieri, Salvatore Mangiafico, David Ozretić, Vanessa Chalumeau, Saima Ahmad, Umair Rashid, Syed Hussain, Seby John, Emma Griffin, John Thornton, José Antônio Fiorot Júnior, Rodrigo Rivera, Nadia Hammami, Anna M. Cervantes‐Arslanian, Hormuzdiyar H. Dasenbrock, Huynh Le Vu, Viet Q. Nguyen, Steven W. Hetts, Romain Bourcier, R. Guilé, Melanie Walker, Malveeka Sharma, Don Frei, Pascal Jabbour, Nabeel Herial, Fawaz Al‐Mufti, Atilla Özcan Özdemi̇r, Özlem Aykaç, Dheeraj Gandhi, Chandril Chugh, Charles Matouk, Pascale Lavoie, Randall C. Edgell, André Beer‐Furlan, Michael Chen, Monika Killer‐Oberpfalzer, Vítor Mendes Pereira, Patrick Nicholson, Vikram Huded, Nobuyuki Ohara, Daisuke Watanabe, Dong Hun Shin, Pedro SC Magalhaes, Raghid Kikano, Santiago Ortega‐Gutiérrez, Mudassir Farooqui, Amal Abou‐Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena Adela Cora, Rotem Sivan-Hoffmann, Roberto Crosa, Markus Möhlenbruch, Simon Nagel, Hosam Al-Jehani, Sunil A. Sheth, Victor S Lopez Rivera, James E. Siegler, Achmad Fidaus Sani, Ajit S Puri, Anna Luisa Kühn, Gianmarco Bernava, Paolo Machi, Daniel Giansante Abud, Octávio Marques Pontes‐Neto, Ajay K. Wakhloo, Barbara Voetsch, Eytan Raz, Shadi Yaghi, Brijesh Mehta, Naoto Kimura, Mamoru Murakami, Jin Soo Lee, Ji Man Hong, Robert Fahed, Gregory Walker, Eiji Hagashi, Steve M Cordina, Hong Gee Roh
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.