2019冠状病毒病大流行对蛛网膜下腔出血住院治疗、动脉瘤治疗及住院死亡率的全球影响：1年随访
Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up.
出版信息
J Neurol Neurosurg Psychiatry. 2022 Jul 28. doi: 10.1136/jnnp-2022-329200.
BACKGROUND
Prior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year.
METHODS
We conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021.
RESULTS
Over the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (-6.4% (95% CI -7.0% to -5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: -5% (95% CI -5.9% to -4.3%), p=0.06; moderate: -8.3% (95% CI -10.2% to -6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12).
CONCLUSION
During the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality.
TRIAL REGISTRATION NUMBER
NCT04934020.
背景
先前的研究表明，在新冠疫情早期，动脉瘤性蛛网膜下腔出血（aSAH）的发病率有所下降。我们评估了新冠疫情第一年与前一年相比，aSAH的发病率、发病严重程度以及破裂动脉瘤治疗方式的差异。
方法
我们开展了一项横断面研究，涵盖49个国家和187个中心。我们记录了新冠住院病例数、aSAH住院病例数、Hunt-Hess分级、血管内栓塞术、开颅夹闭术以及aSAH的院内死亡率。通过国际疾病分类第10版编码或卒中数据库确定2019年1月至2021年5月期间的诊断。
结果
在研究期间，共有16247例aSAH入院病例、344491例新冠住院病例、8300例破裂动脉瘤血管内栓塞术以及4240例破裂动脉瘤开颅夹闭术。与前一年相比，疫情第一年aSAH入院病例数有所下降（-6.4%（95%CI -7.0%至-5.8%），p = 0.0001），在高容量SAH和高容量新冠医院最为明显。蛛网膜下腔出血（SAH）轻度和中度表现有下降趋势（轻度：-5%（95%CI -5.9%至-4.3%），p = 0.06；中度：-8.3%（95%CI -10.2%至-6.7%），p = 0.06），但SAH严重程度较高时无差异。破裂动脉瘤开颅夹闭率保持不变（30.7%对31.2%，p = 0.58），而破裂动脉瘤血管内栓塞术有所增加（53.97%对56.5%，p = 0.009）。aSAH院内死亡率无差异（19.1%对20.1%，p = 0.12）。
结论
在疫情的第一年，aSAH入院病例数减少，原因是aSAH轻度至中度表现减少。破裂动脉瘤血管内栓塞率增加，但破裂动脉瘤开颅夹闭率和aSAH院内死亡率均无变化。
试验注册号
NCT04934020。
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