Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Fiorindi Alessandro, Vezzoli Marika, Doglietto Francesco, Zanin Luca, Saraceno Giorgio, Agosti Edoardo, Barbieri Antonio, Bellocchi Silvio, Bernucci Claudio, Bongetta Daniele, Cardia Andrea, Costi Emanuele, Egidi Marcello, Fioravanti Antonio, Gasparotti Roberto, Giussani Carlo, Grimod Gianluca, Latronico Nicola, Locatelli Davide, Mardighian Dikran, Nodari Giovanni, Poli Jacopo Carlo, Rasulo Frank, Roca Elena, Sicuri Giovanni Marco, Spena Giannantonio, Stefini Roberto, Vivaldi Oscar, Zoia Cesare, Calza Stefano, Fontanella Marco Maria, Cenzato Marco
Аннотация
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.