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Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

T. N. Nguyen 1 D. C. Haussen 2 M. M. Qureshi 3 H. Yamagami 4 T. Fujinaka 4 O. Y. Mansour 5 M. Abdalkader 6 M. Frankel 2 Z. Qiu 7 A. Taylor 8 P. Lylyk 9 O. F. Eker 10 L. Mechtouff 11, 10 M. Piotin 12 F. O. Lima 13 F. Mont'Alverne 13 W. Izzath 14 N. Sakai 15 A. R. Al-Bayati 2 M. Mohammaden 2 L. Renieri 16 S. Mangiafico 16 D. Ozretic 17 V. Chalumeau 18 S. Ahmad 19 U. Rashid 19 S. I. Hussain 20 S. John 20 E. Griffin 21 J. Thornton 21 J. A. Fiorot 22 R. Rivera 23 N. Hammami 24 A. M. Cervantes-Arslanian 6 H. H. Dasenbrock 6 H. L. Vu 25 V. Q. Nguyen 25 S. Hetts 26 R. Bourcier 27 R. Guile 27 M. Walker 28 M. Sharma 28 D. Frei 29 P. Jabbour 30 N. Herial 30 F. Al-Mufti 31 A. O. Ozdemir 32 O. Aykac 32 D. Gandhi 33 C. Chugh 34 C. Matouk 35 P. Lavoie 36 R. Edgell 37 A. Beer-Furlan 38 M. Chen 38 M. Killer-Oberpfalzer 39 V. M. Pereira 40 P. Nicholson 40 V. Huded 41 N. Ohara 15 D. Watanabe 42 D. H. Shin 43 P. S. Magalhaes 44 R. Kikano 45 S. Ortega-Gutierrez 46 M. Farooqui 46 A. Abou-Hamden 47 T. Amano 48 R. Yamamoto 49 A. Weeks 50 E. A. Cora 50 R. Sivan-Hoffmann 51 R. Crosa 52 M. Möhlenbruch 53 S. Nagel 53 H. Al-Jehani 54 S. A. Sheth 55 V. S. Lopez Rivera 55 J. E. Siegler 56 A. F. Sani 57 A. S. Puri 58 A. L. Kuhn 58 G. Bernava 59 P. Machi 59 D. G. Abud 60 O. M. Pontes-Neto 60 A. K. Wakhloo 61 B. Voetsch 61 E. Raz 62 S. Yaghi 62 B. P. Mehta 63 N. Kimura 64 M. Murakami 65 J. S. Lee 66 J. M. Hong 66 R. Fahed 67 G. Walker 67 E. Hagashi 68 S. M. Cordina 69 H. G. Roh 70 K. Wong 71 J. F. Arenillas 72 M. Martinez-Galdamez 73 J. Blasco 74 A. Rodriguez Vasquez 75 L. Fonseca 76 M. L. Silva 76 T. Y. Wu 77 A. Brehm 78 M. Psychogios 78 W. J. Mack 79 M. Tenser 79 T. Todaka 65 M. Fujimura 80 R. Novakovic 81 J. Deguchi 82 Y. Sugiura 83 H. Tokimura 84 R. Khatri 85 M. Kelly 86 L. Peeling 86 Y. Murayama 87 H. S. Winters 88 J. Wong 88 M. Teleb 89 J. Payne 89 H. Fukuda 90 K. Miyake 91 J. Shimbo 92 Y. Sugimura 93 M. Uno 94 Y. Takenobu 95 Y. Matsumaru 96 S. Yamada 97 R. Kono 98 T. Kanamaru 99 M. Morimoto 100 J. Iida 101 V. Saini 102 D. Yavagal 102 S. Bushnaq 103 W. Huang 104 I. Linfante 105 J. Kirmani 106 D. S. Liebeskind 107 V. Szeder 108 R. Shah 109 T. G. Devlin 109 L. Birnbaum 110 J. Luo 111 A. Churojana 112 H. E. Masoud 113 C. Y. Lopez 113 B. Steinfort 114 A. Ma 114 A. E. Hassan 115 A. Al Hashmi 116 M. Mcdermott 117 M. Mokin 118 A. Chebl 119 O. Kargiotis 120 G. Tsivgoulis 121 J. G. Morris 122 C. J. Eskey 123 J. Thon 56 L. Rebello 124 D. Altschul 125 O. Cornett 126 V. Singh 126 J. Pandian 127 A. Kulkarni 127 P. M. Lavados 128 V. V. Olavarria 128 K. Todo 129 Y. Yamamoto 130 G. S. Silva 131 S. Geyik 132 J. Johann 133 S. Multani 134 A. Kaliaev 6 K. Sonoda 135 H. Hashimoto 136 A. Alhazzani 137 D. Y. Chung 6 S. A. Mayer 31 J. T. Fifi 138 M. D. Hill 139 H. Zhang 140 Z. Yuan 141 X. Shang 142 A. C. Castonguay 143 R. Gupta 144 T. G. Jovin 56 J. Raymond 145, 146 O. O. Zaidat 103 R. G. Nogueira 147
Abstract : BACKGROUND: During 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. METHODS: We 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. FINDINGS: There 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\textless0.0001). 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\textless0.0001). 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. INTERPRETATION: There 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.
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T. N. Nguyen, D. C. Haussen, M. M. Qureshi, H. Yamagami, T. Fujinaka, et al.. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. Stroke and Vascular Neurology, London : BMJ, [2016]-, 2021, pp.svn-2020-000695. ⟨10.1136/svn-2020-000695⟩. ⟨inserm-03337432⟩

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