Abstract
BackgroundTo investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic.MethodsIn this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms.ResultsDuring the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years.ConclusionsDespite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.
Highlights
As the COVID-19 pandemic continues to develop, many countries have taken incisive measures to limit the spread of SARS-CoV-2Nils Hecht and Lars Wessels contributed to this work
To analyze the effect of the COVID-19 pandemic on neuro-emergency admissions, we identified all patients that were admitted to the Department of Neurosurgery at the Charité University Hospital in Berlin between February 1 and April 15 in the years 2019 and 2020
We show that despite the restrictive measures associated with COVID-19, patients with neuro-emergencies continue to present across the entire spectrum of disease, which highlights the importance of maintaining a fully operational service in spite of reallocation of medical resources, facilities, and staff
Summary
As the COVID-19 pandemic continues to develop, many countries have taken incisive measures to limit the spread of SARS-CoV-2Nils Hecht and Lars Wessels contributed to this work. This article is part of the Topical Collection on Neurosurgery general [18], such as a restriction of social and economic life These measures, together with the fear of infection [12], have changed peoples’ routines in drastic fashion in a very short period of time [1]. Against this background, fear of COVID-19 may prevent patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics [2, 15]. Conservation of critical healthcare resources remains essential in spite of fighting COVID-19
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