Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy - Report - MDSpire
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Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy
Subarachnoid Hemorrhage Amid COVID-19: Lombardy Hub and Spoke System Study
Overview
This multicenter observational study in Lombardy evaluated the impact of the COVID-19 pandemic on the management and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The study found a significant increase in diagnostic delay during the pandemic but no significant differences in severity at presentation or treatment outcomes compared to the pre-pandemic period.
Background
Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency requiring timely diagnosis and treatment. The COVID-19 pandemic led to healthcare system reorganizations, including the creation of a Hub and Spoke model in Lombardy, Italy, centralizing emergency neurosurgical care. Previous reports on the pandemic's impact on aSAH incidence and management have been conflicting. This study aimed to assess whether the pandemic influenced aSAH management, treatment delays, and outcomes in this regional system.
Data Highlights
Variable
COVID-19 Period (n=72)
Pre-pandemic Period (n=179)
p-value
Female (%)
62.5%
68.2%
0.390
Mean Age (years)
60.39 (SD 13.68)
58.26 (SD 12.87)
0.122
Positive SARS-CoV-2 (%)
5.5%
Not applicable
Not analyzed
Diagnostic Delay (days)
1.06
0.63
0.030
WFNS Grade
Not significantly different
Not significantly different
0.472
Fisher Grade
Not significantly different
Not significantly different
0.255
Key Findings
The number of aSAH cases admitted during the COVID-19 period was 72 compared to 179 in the pre-pandemic period.
There was no significant difference in gender distribution or mean age between the COVID-19 and pre-pandemic groups.
Only 5.5% of patients in the COVID-19 period tested positive for SARS-CoV-2.
Diagnostic delay increased significantly by 68% during the COVID-19 period (1.06 vs. 0.63 days; p=0.030).
Severity at presentation, measured by WFNS and Fisher grades, did not differ significantly between periods.
The Hub and Spoke system effectively centralized aSAH emergency care during the pandemic without worsening clinical outcomes.
Clinical Implications
Clinicians should be aware that the COVID-19 pandemic may cause delays in the diagnosis of aSAH, potentially impacting timely management. The Hub and Spoke healthcare model can maintain effective emergency neurosurgical care during healthcare crises. Continued vigilance is necessary to minimize diagnostic delays and optimize patient outcomes.
Conclusion
The COVID-19 pandemic in Lombardy was associated with increased diagnostic delays for aSAH but did not significantly affect disease severity at presentation or treatment outcomes. The regional Hub and Spoke system successfully maintained emergency care delivery during the crisis.
References
Lombardy Multicenter Study 2021 -- Subarachnoid Hemorrhage from Aneurysms Amid the COVID-19 Pandemic
by Alessandro Fiorindi, Marika Vezzoli, Francesco Doglietto, Luca Zanin, Giorgio Saraceno, Edoardo Agosti, Antonio Barbieri, Silvio Bellocchi, Claudio Bernucci, Daniele Bongetta, Andrea Cardia, Emanuele Costi, Marcello Egidi, Antonio Fioravanti, Roberto Gasparotti, Carlo Giussani, Gianluca Grimod, Nicola Latronico, Davide Locatelli, Dikran Mardighian, Giovanni Nodari, Jacopo Carlo Poli, Frank Rasulo, Elena Roca, Giovanni Marco Sicuri, Giannantonio Spena, Roberto Stefini, Oscar Vivaldi, Cesare Zoia, Stefano Calza, Marco Maria Fontanella, Marco Cenzato
