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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this observational multicenter cohort study, patients aged 18\u00a0years 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\u20132018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 \u201cdiagnostic delay\u201d was significantly increased (+\u200968%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63\u00a0days, respectively,\n                      <jats:italic>p<\/jats:italic>\n                      -value\u2009=\u20090.030), while \u201ctherapeutic delay\u201d did not differ significantly between the two periods (0.89 vs. 0.74\u00a0days,\n                      <jats:italic>p<\/jats:italic>\n                      -value\u2009=\u20090.183). 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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed\n                      <jats:italic>p<\/jats:italic>\n                      -values\u2009&lt;\u20090.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We documented a significantly increased \u201cdiagnostic delay\u201d 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 \u201ctherapeutic delay\u201d and led to results overall comparable to the control period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-021-05013-9","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T02:02:41Z","timestamp":1635127361000},"page":"141-150","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, 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Patients\u2019 consent was obtained at the time of treatment for the use of data for scientific purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study at the time of treatment. The submission does not include images or enough data that may identify the persons, that is why additional informed consent was not obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}