Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
Acta Neurochir (Wien). 2022 Jan;164(1):141-150. doi: 10.1007/s00701-021-05013-9. Epub 2021 Oct 25.
Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort.
In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017-2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed.
Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The "diagnostic delay" was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while "therapeutic delay" did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia.
We documented a significantly increased "diagnostic delay" for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a "therapeutic delay" and led to results overall comparable to the control period.
伦巴第大区是意大利受 COVID-19 大流行第一阶段影响最严重的地区，为了应对紧急情况，包括蛛网膜下腔出血（aSAH），进行了紧急重组。本研究的目的是确定 COVID-19 爆发期间 aSAH 的人口统计学、临床和治疗特征，并将其与历史队列进行比较。
在这项观察性多中心队列研究中，纳入了 2020 年 3 月 9 日至 5 月 10 日在伦巴第大区参与中心诊断为 aSAH 的年龄在 18 岁或以上的患者（COVID-19 组）。为了最大程度地减少与可能的 aSAH 季节性相关的偏倚，对照组由 2017 年至 2019 年 3 月 9 日至 5 月 10 日期间诊断为 aSAH 的患者组成（大流行前组）。共收集了 23 项人口统计学、临床和治疗特征。进行了统计学分析。
COVID-19 期间纳入了 72 名患者，对照组纳入了 179 名患者，在 14 个中心进行了研究。仅 4 名患者 SARS-CoV-2 检测呈阳性。COVID-19 组的“诊断延迟”（1.06 天）明显高于大流行前组（0.63 天，p 值=0.030），而两个时期的“治疗延迟”没有显著差异（0.89 天与 0.74 天，p 值=0.183）。COVID-19 期间预后不良（出院时 GOS 评分 1-3）的患者比例较高（54.2%），而大流行前组（40.2%）较低（p=0.044）。在将结局二分类为格拉斯哥结局量表（GOS）的逻辑回归分析中，有 5 个变量的 p 值<0.05：入院时年龄、WFNS 分级、治疗（无）、入住 ICU 天数和缺血。
我们记录了伦巴第大区 COVID-19 首次爆发期间蛛网膜下腔出血的“诊断延迟”明显增加。然而，尽管医疗系统正面临着巨大的困难，但伦巴第大区的重组模式允许集中治疗神经外科急症，如 aSAH，避免了“治疗延迟”，并导致总体结果与对照组相当。
