Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy - Scorecard - MDSpire

Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

  • 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

  • October 25, 2021

  • 0 min

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Clinical Scorecard: Subarachnoid Hemorrhage from Aneurysms Amid the COVID-19 Pandemic: A Multicenter Observational Study in Lombardy's Hub and Spoke Healthcare System

At a Glance

CategoryDetail
ConditionAneurysmal subarachnoid hemorrhage (aSAH)
Key MechanismsRupture of cerebral aneurysm causing hemorrhage; time-dependent neurosurgical emergency
Target PopulationAdults aged 18 years or older diagnosed with aSAH in Lombardy region
Care SettingNeurosurgical Hub hospitals within a regional Hub and Spoke emergency network during COVID-19 pandemic

Key Highlights

  • COVID-19 pandemic led to reorganization of neurosurgical care into Hub and Spoke system centralizing aSAH treatment.
  • Diagnostic delay for aSAH increased significantly (+68%) during COVID-19 lockdown compared to pre-pandemic period.
  • No significant differences in severity (WFNS, Fisher grades) or gender distribution between COVID-19 and pre-pandemic groups.

Guideline-Based Recommendations

Diagnosis

  • Urgent CT scan for suspected aSAH to confirm diagnosis.
  • Screen all patients for SARS-CoV-2 infection using RT-PCR and chest imaging during pandemic.
  • Use transcranial Doppler (TCD) to diagnose vasospasm (MFV ≥120 cm/s and Lindegaard ratio ≥3).

Management

  • Centralize aSAH treatment in designated Hub hospitals during pandemic to optimize resource allocation.
  • Prioritize emergency hospitalization and treatment of aSAH patients; immediate referral from Spoke to Hub hospitals.
  • Consider shift towards endovascular treatment due to increased surgical risk in COVID-19 patients.

Monitoring & Follow-up

  • Monitor for SAH-related complications including vasospasm and ischemia via imaging and TCD.
  • Track delays in diagnosis and treatment times to improve outcomes.
  • Assess Glasgow Outcome Scale (GOS) at discharge to evaluate patient recovery.

Risks

  • Increased diagnostic delay during pandemic may worsen outcomes.
  • Potential increased surgical risk in COVID-19 positive patients necessitating treatment adjustments.
  • Conversion of neurosurgery units to COVID wards may limit access to timely neurosurgical care.

Patient & Prescribing Data

72 patients during COVID-19 lockdown and 179 patients from pre-pandemic years in Lombardy region

Treatment modalities and timing were analyzed; slight increase in diagnostic delay during COVID-19; low SARS-CoV-2 positivity (5.5%) among aSAH patients.

Clinical Best Practices

  • Implement regional Hub and Spoke systems to centralize emergency neurosurgical care during pandemics.
  • Ensure rapid diagnostic imaging and minimize delays from symptom onset to diagnosis.
  • Screen all aSAH patients for COVID-19 to guide treatment planning and infection control.
  • Use standardized scales (WFNS, Fisher, GOS) for consistent assessment and outcome tracking.
  • Maintain multidisciplinary coordination to manage SAH-related and COVID-related complications.

References

Original Source(s)

Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

  • 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

  • October 25, 2021

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