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

BackgroundDuring 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.MethodsWe 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.FindingsThere 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.InterpretationThere 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.