13-Delays to Presentation and Outcomes After Aneurysmal Subarachnoid Hemorrhage in the SARS-CoV-2 Era
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Neuroscience, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Feras Akbik, MD, PhD

Introduction/Hypothesis: Increasing reports suggest that patients have been reluctant to present for care due to fear of contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), even in the setting of ischemic stroke or myocardial infarction. The impact of the ongoing pandemic on patients with aneurysmal subarachnoid hemorrhage (aSAH) remains unknown.

Methods: We performed a retrospective cohort study of all patients presenting to a single referral center in Atlanta, Georgia, USA with aSAH between 2012 and 2020. SARS-CoV-2 was first reported in Georgia on March 2, 2020. All patients presenting from March through June of a given calendar year were compared from the pre-SARS-CoV-2 era (2012-2019) to the SARS-CoV-2 era (2020). Patient characteristics, latency from ictus to presentation, and clinical outcomes were compared.

Results: A total of 472 patients presented with aSAH during the study period, with comparable distribution in the age, sex, and Hunt and Hess grade on presentation. The mean latency in days from ictus to presentation was significantly longer in 2020 when compared to the pre-SARS-CoV-2 era (2.3, + 3.0 vs. 0.9 + 2.2, respectively, p<.05). Absolute rates of discharge home or in-hospital mortality were not significantly different. In binary regression analysis, patients were more likely to present post-bleed day 2 or after (OR 3.9, 1.9-8.1, p<.05). This effect was driven by delays to presentation in low grade aSAH (OR 3.2, 1.1-9.25, p<.05) with no difference to time in presentation in high-grade aSAH (2.3, 0.25 – 21.6). The delay to presentation was persistent on multiple binary regression analysis after controlling for age and grade (aOR 3.7, 1.7-8.0, p<.05). There was a non-significant trend towards increased mortality in the SARS-CoV-2 era on multiple regression analysis (2.78, 0.95-8.16).

Conclusions: Similar to patients with myocardial and cerebral infarctions, patients are presenting for care later after an aSAH. This effect is driven by low grade aSAH, as high grade aSAH patients with a more fulminant presentation are still largely presenting within the first day, similar to the pre-SARS-CoV-2 era. These data highlight the ongoing collateral damage of the SARS-CoV-2 pandemic and need for vigilant public health efforts to encourage rapid presentation for care.


Meta Tag
Content Type Presentation
Knowledge Area Neuroscience
Knowledge Area Crisis Management
Knowledge Level Advanced
Membership Level Select
Tag Aneurysmal Subarachnoid Hemorrhage
Tag COVID-19
Year 2021
COVID-19 pandemic
aneurysmal subarachnoid hemorrhage
ruptured brain aneurysm
delay in presentation
increased in-hospital deaths


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