Impact of COVID-19 on seizure-related emergency attendances and hospital admissions — A territory-wide observational study

Abstract

This is a territory-wide study to investigate the impact of coronavirus disease 2019 (COVID-19) pandemic on Accident and Emergency Department (A&E) attendances and acute ward admissions for seizures. Adult patients who presented to the A&E with seizures from January 23, 2020 to March 24, 2020 (study period) were included and compared with parallel intervals from 2015 to 2019 (control periods). Preexisting time trend in control periods and potential changes during COVID-19 were analyzed by Poisson, negative and logistic regression models. Accident and Emergency Department attendances and ward admissions for seizures decreased significantly during the COVID-19 pandemic. A total of 319 and 230 recorded ward admissions and A&E attendances for seizures were identified during the study period in 2020, compared with 494 and 343 per annum, respectively in the control periods. The ratio of acute ward admission per A&E attendance for seizures did not change significantly. Intensive care utility and mortality rates remained stable. For some patients, delaying medical attention due to fear of nosocomial COVID-19 cross-infection may lead to severe or even life-threatening consequences. This change in medical help-seeking behavior calls for new medical care models to meet the service gap. Education to patients with epilepsy and their caregivers is of utmost importance during this pandemic.

Impact of COVID-19 on quality of life in people with epilepsy, and a multinational comparison of clinical and psychological impacts

“…[3] The complete restriction of movement and assembly resulted in postponement of healthcare visits in Malaysia, similarly in many other countries. This unprecedented loss of access to healthcare is postulated to give rise to worsening seizure control and anxiety, which were reported in many countries in most continents, including China [4][5][6], Hong Kong [7], Pakistan [8] and Saudi Arabia [9] in Asia, Brazil [10] in South America, Spain [11,12] and Italy [13] in Europe, and United Stated of America. [14] However, most studies analyze mainly on the direct impact of AEDs on the psychological and clinical consequences, but not the access to emergency and outpatient services.…”

Did the COVID-19 pandemic impact help-seeking behavior for seizure management? A Google Trends™ study

“…Similarly, Walker et al demonstrated a significant overlap between the health queries about loss-of-smell globally with the onset of the COVID-19 pandemic [19] . Recent studies have shown a significant drop in acute admissions for seizures since the pandemic [20] , [21] . This is contrary to the predictions of increased seizure incidence because of acute mental stress, sleep deprivation, reduced access to healthcare and pharmacies, and drastic changes to clinical practice [20] , [22] .…”

“…Recent studies have shown a significant drop in acute admissions for seizures since the pandemic [20,21]. This is contrary to the predictions of increased seizures incidence because of acute mental stress, sleep deprivation, reduced access to healthcare and pharmacies, and drastic changes to clinical practice [20,22].…”

Impact of the COVID-19 Epidemic on the Routine Emergency Services in a Tertiary Hospital, China: A Retrospective Cohort Study

“…[15][16][17][18][19] Although we cannot yet determine whether these psychological changes directly affect the public's visit behavior, many studies have found a shift in public behavior with anxiety over attending hospitals during the pandemic and associated with a significant reduction in ED presentations. [20][21][22][23][24] From the above data, we can conclude that the pandemic has changed people's behavioral patterns, especially the process of seeking medical care. These similar phenomena indicated that people might keep avoiding the hospital to the detriment of their health.…”

“…We further analyzed the clinical data of the patients who died in the ED. The APACHE II score of patients who died in the 2020 study period was slightly higher compared with that of 2019, which were 28 (IQR 18-35) and [19][20][21][22][23][24][25][26] respectively (p= 0.022). Whereas, the ED elapsed time dropped from 1.4 (IQR 0.2-4.8) days in 2019 to 0.2 in 2020 (IQR 0.1-1.2) (p=0.016) (Table 1).…”