Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
Authors: Nguyen Thanh N , Haussen Diogo C , Qureshi Muhammad M , Yamagami Hiroshi , Fujinaka Toshiyuki , Mansour Ossama Y , Abdalkader Mohamad , Frankel Michael , Qiu Zhongming , Taylor Allan , Lylyk Pedro , Eker Omer F , Mechtouff Laura , Piotin Michel , Lima Fabricio Oliveira , Mont'Alverne Francisco , Izzath Wazim , Sakai Nobuyuki , Mohammaden Mahmoud , Al-Bayati Alhamza R , Renieri Leonardo , Mangiafico Salvatore , Ozretic David , Chalumeau Vanessa , Ahmad Saima , Rashid Umair , Hussain Syed Irteza , John Seby , Griffin Emma , Thornton John , Fiorot Jose Antonio , Rivera Rodrigo , Hammami Nadia , Cervantes-Arslanian Anna M , Dasenbrock Hormuzdiyar H , Vu Huynh Le , Nguyen Viet Quy , Hetts Steven , Bourcier Romain , Guile Romain , Walker Melanie , Sharma Malveeka , Frei Don , Jabbour Pascal , Herial Nabeel , Al-Mufti Fawaz , Ozdemir Atilla Ozcan , Aykac Ozlem , Gandhi Dheeraj , Chugh Chandril , Matouk Charles , Lavoie Pascale , Edgell Randall , Beer-Furlan Andre , Chen Michael , Killer-Oberpfalzer Monika , Pereira Vitor Mendes , Nicholson Patrick , Huded Vikram , Ohara Nobuyuki , Watanabe Daisuke , Shin Dong Hun , Magalhaes Pedro SC , Kikano Raghid , Ortega-Gutierrez Santiago , Farooqui Mudassir , Abou-Hamden Amal , Amano Tatsuo , Yamamoto Ryoo , Weeks Adrienne , Cora Elena A , Sivan-Hoffmann Rotem , Crosa Roberto , Möhlenbruch Markus , Nagel Simon , Al-Jehani Hosam , Sheth Sunil A , Lopez Rivera Victor S , Siegler James E , Sani Achmad Fidaus , Puri Ajit S , Kuhn Anna Luisa , Bernava Gianmarco , Machi Paolo , Abud Daniel G , Pontes-Neto Octavio M , Wakhloo Ajay K , Voetsch Barbara , Raz Eytan , Yaghi Shadi , Mehta Brijesh P , Kimura Naoto , Murakami Mamoru , Lee Jin Soo , Hong Ji Man , Fahed Robert , Walker Gregory , Hagashi Eiji , Cordina Steve M , Roh Hong Gee , Wong Ken , Arenillas Juan F , Martinez-Galdamez Mario , Blasco Jordi , Rodriguez Vasquez Alejandro , Fonseca Luisa , Silva M Luis , Wu Teddy Y , John Simon , Brehm Alex , Psychogios Marios , Mack William J , Tenser Matthew , Todaka Tatemi , Fujimura Miki , Novakovic Roberta , Deguchi Jun , Sugiura Yuri , Tokimura Hiroshi , Khatri Rakesh , Kelly Michael , Peeling Lissa , Murayama Yuichi , Winters Hugh Stephen , Wong Johnny , Teleb Mohamed , Payne Jeremy , Fukuda Hiroki , Miyake Kosuke , Shimbo Junsuke , Sugimura Yusuke , Uno Masaaki , Takenobu Yohei , Matsumaru Yuji , Yamada Satoshi , Kono Ryuhei , Kanamaru Takuya , Morimoto Masafumi , Iida Junichi , Saini Vasu , Yavagal Dileep , Bushnaq Saif , Huang Wenguo , Linfante Italo , Kirmani Jawad , Liebeskind David S , Szeder Viktor , Shah Ruchir , Devlin Thomas G , Birnbaum Lee , Luo Jun , Churojana Anchalee , Masoud Hesham E , Lopez Carlos Ynigo , Steinfort Brendan , Ma Alice , Hassan Ameer E , Al Hashmi Amal , McDermott Mollie , Mokin Maxim , Chebl Alex , Kargiotis Odysseas , Tsivgoulis Georgios , Morris Jane G , Eskey Clifford J , Thon Jesse , Rebello Leticia , Altschul Dorothea , Cornett Oriana , Singh Varsha , Pandian Jeyaraj , Kulkarni Anirudh , Lavados Pablo M , Olavarria Veronica V , Todo Kenichi , Yamamoto Yuki , Silva Gisele Sampaio , Geyik Serdar , Johann Jasmine , Multani Sumeet , Kaliaev Artem , Sonoda Kazutaka , Hashimoto Hiroyuki , Alhazzani Adel , Chung David Y , Mayer Stephan A , Fifi Johanna T , Hill Michael D , Zhang Hao , Yuan Zhengzhou , Shang Xianjin , Castonguay Alicia C , Gupta Rishi , Jovin Tudor G , Raymond Jean , Zaidat Osama O , Nogueira Raul G ,   SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO)
Published: March 2021

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.