Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Alessandro Fiorindi, Marika Vezzoli, Francesco Doglietto, Luca Zanin, Giorgio Saraceno, Edoardo Agosti, Antonio Barbieri, Silvio Bellocchi, Claudio Bernucci, Daniele Bongetta, Andrea Cardia, Emanuele Costi, Marcello Egidi, Antonio Fioravanti, Roberto Gasparotti, Carlo Giussani, Gianluca Grimod, Nicola Latronico, Davide Locatelli, Dikran MardighianGiovanni Nodari, Jacopo Carlo Poli, Frank Rasulo, Elena Roca, Giovanni Marco Sicuri, Giannantonio Spena, Roberto Stefini, Oscar Vivaldi, Cesare Zoia, Stefano Calza, Marco Maria Fontanella, Marco Cenzato

Research output: Contribution to journalArticlepeer-review


Background: 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. 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.

Original languageEnglish
JournalActa Neurochirurgica
Publication statusAccepted/In press - 2021


  • COVID-19
  • Hub and Spoke
  • Intracranial bleeding aneurysm
  • Logistic regression
  • Pandemic
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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