Abstract
Background: The COVID-19 pandemic has seriously impacted healthcare systems worldwide. Admissions for various non-COVID-19 emergencies have significantly decreased. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department.Methods: In a retrospective analysis of admissions to the emergency department of the University Hospital Mannheim from January to June 2020 and the corresponding time period in 2019, all patients admitted for either traumatic or non-traumatic intracranial hemorrhage were evaluated. Poisson regression was performed to analyze changes in admission rates as a function of year, epoch (COVID-19-epoch, March to April 2020 and corresponding months 2019; non-COVID-19-epoch, January to February and May to June 2019/2020) and the interaction of year and epoch (reflecting the impact of the pandemic and subsequent lockdown measures).Results: Overall, 320 patients were included in the study. During the COVID-19-epoch, admission rates for spontaneous intracranial hemorrhage decreased significantly by 42.1% (RR 0.579, p = 0.002, 95% confidence interval 0.410–0.818). Likewise, admission rates for traumatic intracranial hemorrhage decreased significantly by 53.7% [RR = 0.463, p < 0.001, 95% confidence interval (CI) 0.358–0.599].Conclusion: The decrease of spontaneous intracranial hemorrhages may be a consequence of underutilization of the healthcare system whereas decreasing rates of traumatic intracranial hemorrhage admissions may predominantly reflect a decrease in true incidence rates due to lockdown measures with restricted mobility. Raising patient awareness to seek emergency healthcare for acute neurological deficits during lockdown measures is important to ensure appropriate emergency care for patients with intracranial hemorrhage.
Highlights
The COVID-19 pandemic has a deep impact on healthcare systems worldwide
Over the cumulative observation periods 01-06/2019 and 0106/2020, 320 patients were admitted with the diagnosis of either spontaneous or traumatic intracranial hemorrhage with a mean monthly admission rate of 26.67 cases [standard deviation (SD) ± 6.050]
Non-traumatic intracranial hemorrhages, predominantly spontaneous intracerebral hemorrhages, comprised 43.1% of the cases, and 40.6% of patients were on some form of anticoagulant medication at the time of admission (Table 1)
Summary
The COVID-19 pandemic has a deep impact on healthcare systems worldwide. Whereas the risk of both spontaneous and traumatic intracranial hemorrhage increases with age, traumatic brain injury with intracranial bleeding complications affects the younger [10] with substantial loss of disabilityadjusted life-years. In both cases, an optimal emergency care is of utmost importance to attenuate a potentially fatal course of disease. The COVID-19 pandemic has seriously impacted healthcare systems worldwide. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department
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