Hospital admissions of spontaneous subarachnoid hemorrhage during the COVID-19 pandemic: Southeastern Turkey experience

Abstract

Objective: This study aimed to determine if the coronavirus disease 2019 (COVID-19) pandemic had any impact on admission patterns for subarachnoid hemorrhage (SAH) during 1st and 2nd waves and in-between in a tertiary institution in southeastern Turkey. Methods: Three periods were determined during the pandemic: First and second peaks (April 1-May 1, 2020 and November 18-December 18, 2020, respectively) and the slowdown period (July 5-August 4, 2020) where the daily new cases hit its lowest. We retrospectively collected data of the patients with SAH who were admitted to our institution within these periods during 2020 (the pandemic) and 2019 (the year before the pandemic). Demographic data, time between symptom onset and admission, Glasgow Coma Scale (GCS), Fisher score, World Federation of Neurosurgical Societies (WFNS), presence of intracerebral hemorrhage, intraventricular hemorrhage, hydrocephalus, type of SAH (aneurysmal vs non-aneurysmal) were recorded and compared between the pandemic and pre-pandemic periods. Results: The number of admissions in first peak, slowdown, and second peak during the pandemic was 11, 15, and 17, respectively. They did not differ significantly from corresponding periods in 2019 (17, 7, and 10, respectively) (all P>0.05). The mean time from onset to admission to hospital was similar between pandemic and 2019 (ranging between 0.40-2.00 days in 2020 compared to ranging between 1.12-2.29 days in 2019). The rate of cases with worse neurological condition on admission turned out to be lower during the first peak of the pandemic compared to previous year (9.1% vs 29.4%, P=0.029), but showed no difference in the remaining two periods. The incidence of accompanying pathologies (intracerebral hemorrhage, intraventricular hemorrhage, and hydrocephalus) was also similar between the periods in 2020 and their counterparts in 2019. Rate of non-aneurysmal cases ranged between 11.1%-45.5% in 2020 compared to 10.0%-57.1% in 2019 (all P>0.05). Conclusion: The study showed that hospital admission patterns for SAH was not affected by COVID-19 pandemic in the southeastern Turkey, unlike other reports. This may be due to different behavioral characteristics of the study population and capability of health care system to cope with high number of patient admissions.