Involuntary ambulatory triage during the COVID-19 pandemic – A neurosurgical perspective

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under "lockdown" conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions. Methods This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16 th to April 16 th , 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies. Results A total of 243 in-patients were treated between March 16 th and April 16 th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Gö ttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%. Conclusion Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in

Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center

“…Contrary to what was observed in Germany, where emergency admissions decreased by 44.7% ± 0.7% during the pandemic, we observed an increase of 30% in medical evaluations in our emergency department. 65 The number of neurosurgical beds was significantly decreased (approximately a 70% reduction at our center), which is similar to a report from Europe. 66 This may be due to large neurosurgery centers in Mexico being reconverted as COVID-19 centers, and therefore their patient populations were referred to our hospital.…”

Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery

“…A similar trend in 2 non-LMIC hospitals is observed, where neurological emergency admissions during the lockdown in Germany declined by 44.7%. The consequences of this morbidity and mortality remain to be seen 22 (#206, Level II). Emergency department (ED) visits declined by 23% for myocardial infarction, 20% for stroke, and 10% for hyperglycemic crisis between March and May 2020 compared to 10 weeks prior to the emergency declaration for COVID-19 in the United States 23 (#150, Level VII).…”

Declining Numbers of Neurosurgical Emergencies at a German University Medical Center during the Coronavirus Lockdown

“…Our tertiary medical center has a catchment area population of 2.2 million, who live in a rather rural area of 20,000 km 2 . Consequently, the distance patients have to cover to get to a health care provider, especially in the case of a nationwide lockdown, appears to be an interesting aspect.…”

“…In comparable centers in Germany, neurosurgical emergency admissions also strongly declined during lockdown. 2,3 Another center in Helsinki, however, did not find any changes in the number of ICU admissions due to traumatic brain injury (TBI) or subarachnoid hemorrhage. 4 In the larger European perspective, Mathiesen et al found in a survey study that 18 of 25 centers reported a lower number of ICU-treated TBI patients, whereas their investigation focused on the resource-saving measurements that were taken rather than the factors concerning the patients being admitted to the emergency unit.…”