Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Thanh N. Nguyen*, Muhammad M. Qureshi, SVIN Global COVID-19 SAH Registry, Piers Klein, Hiroshi Yamagami, Robert Mikulik, Nima Etminan, Mohamad Abdalkader, Ossama Yassin Mansour, Anna Czlonkowska, Hannah Lo, Anvitha Sathya, Jelle Demeestere, Georgios Tsivgoulis, Nobuyuki Sakai, Petra Sedova, Espen Saxhaug Kristoffersen, Mahmoud Mohammaden, Virginia Pujol Lereis, Sergio Daniel ScolloAlice Ma, Aminur Rahman, Thomas Bonnet, Jeroen Cortier, Sylvie De Raedt, Robin Lemmens, Noemie Ligot, Raquel C.T. Hidalgo, Daissy Liliana Mora Cuervo, Luciana De Oliveira Neves, Marco Tulio Salles Rezende, Igor Bessa Santiago, Alexander Sirakov, Stanimir Sirakov, Elena Adela Cora, Michael E. Kelly, Pascale Lavoie, Lissa Peeling, Aleksandra Pikula, Rodrigo Rivera, Hui Sheng Chen, Yimin Chen, Hongliang Fang, Marina Roje Bedekovic, Hrvoje Budincevic, J. J. Strossmayer, Martin Čabal, Emanuela Hrabanovska, Lubomir Jurak, Diederik Dippel, Leon Rinkel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1028-1038
Number of pages11
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number10
Publication statusPublished - 1 Oct 2022

Bibliographical note

Funding Information:
These coauthors have the following funding: support by STROCZECH within CZECRIN Large Research Infrastructure (number LM2018128) funded by the state budget of the Czech Republic. FNUSA: PS, RM, NCB and JR; lFN Hradec Králové: RH; FESO, FEANNemocnice Jihlava: OS; Hornická Nemocnice, a.s.: HP; Nemocnice Liberec: LJ; Nemocnice Na Homolce: MK; Vojenská Nemocnice Praha: MS, FP reported royalties from Springer Nature Publishing Group and Elsevier, Research Grant from Transilvania University Brasov, speaker fees and honoraria from International Parkinson and Movement Disorders Society, AbbVie, outside the submitted work. RM was supported by project number CA18118, IRENE COST Action funded by COST Association, by the IRIS-TEPUS project number LTC20051 from the INTER-EXCELLENCE INTER-COST Program of the Ministry of Education, Youth and Sports of the Czech Republic and by STROCZECH within CZECRIN Large Research Infrastructure number LM2018128 funded by the state budget of the Czech Republic. TNN reports research support from Medtronic and the Society of Vascular and Interventional Neurology. RGN reported consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby and Synchron and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze; and investments in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic and Viseon. AP is a consultant for Cerenovus, CereVasc, Merit and Medtronic; received research grants from Medtronic. Stocks in InNeuroCo, Galaxy, Agile, Perfuze and NTI. HY reported research grants from Bristol-Myers Squibb, lecturer’s fees from Bayer, Daiichi-Sankyo and Stryker, and membership in the advisory boards for Daiichi-Sankyo outside the submitted work. Dr. Siegler reports speakers bureau from AstraZeneca, consulting fees from Ceribell.

Funding Information:
The study was funded by the Society of Vascular and Interventional Neurology research pilot grant.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.


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