Evidence map›Paper›PMID 34694465›Full record

Observational studyActa neurochirurgica2022

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 and 22 more

Open access · hybridAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Acta neurochirurgica, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
0.8field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors at 15 institutions in 1 country.

Alessandro FiorindiNeurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy. alessandro.fiorindi@gmail.com.ORCID http://orcid.org/0000-0003-2917-367X
Marika VezzoliBiostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
Francesco DogliettoNeurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Luca ZaninNeurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Giorgio SaracenoNeurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Edoardo AgostiNeurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Antonio BarbieriNeurosurgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy.
Silvio BellocchiNeurosurgery, Sant'Anna Hospital, Como, Italy.
Claudio BernucciNeurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Daniele BongettaNeurosurgery, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli-Sacco, Milan, Italy.
Andrea CardiaNeurosurgery, Humanitas Clinical and Research Center-IRRCS, Rozzano, Milan, Italy.
Emanuele CostiNeurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Marcello EgidiNeurosurgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy.
Antonio FioravantiNeurosurgery, Cremona Hospital, Cremona, Italy.
Roberto GasparottiNeuroradiology, Spedali Civili, University of Brescia, Brescia, Italy.
Carlo GiussaniNeurosurgery, San Gerardo Hospital, Monza, Università Milano-Bicocca, Milan, Italy.
Gianluca GrimodNeurosurgery, ASST Lecco, A. Manzoni Hospital, Lecco, Italy.
Nicola LatronicoNeuroAnesthesia and ICU, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy.
Davide LocatelliNeurosurgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
Dikran MardighianNeuroradiology, Spedali Civili, University of Brescia, Brescia, Italy.
Giovanni NodariNeurosurgery, Cremona Hospital, Cremona, Italy.
Jacopo Carlo PoliNeurosurgery, Sant'Anna Hospital, Como, Italy.
Frank RasuloNeuroAnesthesia and ICU, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy.
Elena RocaNeurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy.
Giovanni Marco SicuriNeurosurgery, Legnano Hospital, Legnano, Italy.
Giannantonio SpenaNeurosurgery, ASST Lecco, A. Manzoni Hospital, Lecco, Italy.
Roberto StefiniNeurosurgery, Legnano Hospital, Legnano, Italy.
Oscar VivaldiNeurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy.
Cesare ZoiaNeurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Stefano CalzaBiostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
Marco Maria Fontanella *Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
Marco Cenzato *Neurosurgery, Grande Ospedale Metropolitano di Niguarda, Milan, Italy.
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia · ITUniversity of Brescia · ITAlessandro Manzoni Hospital · ITAzienda Ospedaliera Ospedale Civile di Legnano · ITFondazione Poliambulanza Istituto Ospedaliero · ITIstituti Ospitalieri di Cremona · ITOspedale Papa Giovanni XXIII · ITOspedale San Carlo · ITOspedale Sant'Anna · ITASST Fatebenefratelli Sacco · ITAzienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · ITHumanitas University · ITPoliclinico San Matteo Fondazione · ITUniversity of Insubria · ITUniversity of Milano-Bicocca · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLombardy 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.

methodsIn 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.

resultsSeventy-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.

conclusionsWe 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.

Indexed as

COVID-19Subarachnoid HemorrhageCohort StudiesHumansPandemicsSARS-CoV-2Treatment OutcomeCOVID-19Hub and SpokeIntracranial bleeding aneurysmLogistic regressionPandemicSubarachnoid hemorrhage

Identifiers

PMID34694465
PMCPMC8542653
OpenAlexW3208481614

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.