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Changes in Demographic and Diagnostic Spectra of Patients with Neurological Symptoms Presenting to an Emergency Department During the COVID-19 Pandemic: A Retrospective Cohort Study

Authors Hoyer C, Grassl N, Bail K, Stein P, Ebert A, Platten M, Szabo K

Received 25 July 2020

Accepted for publication 28 August 2020

Published 30 September 2020 Volume 2020:16 Pages 2221—2227

DOI https://doi.org/10.2147/NDT.S273913

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder


Carolin Hoyer, Niklas Grassl, Kathrin Bail, Patrick Stein, Anne Ebert, Michael Platten, Kristina Szabo

Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany

Correspondence: Carolin Hoyer
Department of Neurology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68 167 Mannheim, Germany
Tel +49-621-383-5268
Fax +49-621-383-3807
Email carolin.hoyer@umm.de

Objective: To analyse the characteristics of patients with neurological complaints seeking evaluation in an interdisciplinary emergency department (ED) during the rise of the COVID-19 pandemic in Germany.
Methods: In this retrospective study, data on the number of ED presentations due to neurological complaints in weeks 1– 15/2020 were collected. In addition, hospital chart data of patients referred for neurological evaluation during weeks 12– 15/2020 when the pandemic began impacting on public life in Germany were analysed regarding demographic information, chief complaints, modes of presentation and disposition and ED discharge diagnosis. Both data sets were compared to respective periods from 2017.
Results: During the surge of COVID-19, we found a significant decrease of the total number of neurological ED patients by 47.6%. Comparing weeks 12– 15 of 2017 and 2020, we found a decrease in the number of patients of < 30 years (p< 0.001) and an increase of those 70 years (p< 0.001). A higher proportion of patients were admitted to escalated care (p=0.03), and fewer patients were discharged against medical advice (p< 0.001). In addition, the ratio of less acute diagnoses (eg, benign headaches) declined significantly.
Conclusion: Our findings suggest that the pandemic has contributed to a – potentially transient – reframing of laypeople’s perception of urgency and necessity for emergency presentation. The establishment and promotion of health-care structures and services like telemedical consultations and the creation of safe ED environments will be essential to enable adequate delivery of care in potential future waves of the pandemic.

Keywords: pandemics, COVID-19, emergency neurology

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