&lt;p&gt;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&lt;/p&gt;

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

doi:10.2147/ndt.s273913

Cited by 4 publications

(8 citation statements)

References 33 publications

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“…In terms of disposition, 55% of enrolled patients were admitted to the hospital, 41.8% were determined for outpatient follow-up, and 1.1% were transferred to another hospital. The admission rate was similar to that reported by Hoyer et al and Linden et al (50.0–57.7%) [ 1 , 3 , 10 ].…”

Section: Discussionsupporting

confidence: 90%

“…The diagnoses made most frequently by neuro-emergency experts in the ED were acute ischemic stroke, benign paroxysmal positional vertigo, vestibular neuritis, seizures, cerebral hemorrhage, and metabolic encephalopathy. The order of diagnosis frequency in other studies was AIS, seizure, and headache [ 1 , 5 , 10 , 13 , 14 ]; our results had similar AIS frequency but fewer cases of headache. Most cases of primary headache with no abnormal findings on brain CT scans were discharged by the ED physicians after controlling their symptoms and referred for outpatient treatment.…”

Section: Discussionsupporting

confidence: 70%

“…Of the patients enrolled in our study, 1090 (94.4%) underwent CT, which was remarkably higher than 37.6 and 65.5% in other studies [10,11], possibly due to differences in each country's health care insurance policy. CT is the most frequently performed basic modality for the quick and accurate identification of acute hemorrhage, mass lesions, and a recent cerebral infarction with acute neurological symptoms.…”

Section: Modalities For Neurological Evaluationcontrasting

confidence: 55%

“…The mean age was 62.9 years, and the proportion of patients aged 18–40 years was the lowest. Only one such study has been conducted during the COVID-19 pandemic [ 10 ]; consequently, we compared our findings with studies conducted before the pandemic. Previous studies have shown that the number of patients visiting the ED for neurological symptoms is small among young people, and this trend continued during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

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Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Jung

Kim

et al. 2021

IJERPH

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We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 70%

Section: Modalities For Neurological Evaluationcontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Jung

Kim

et al. 2021

IJERPH

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“…Moreover, changes in recanalization therapy rates were attributed to underlying presentation delays [ 5 ], which may in part be caused by patients’ indecisiveness as to whether they should present to a hospital. In a study of emergency department (ED) patients with neurological complaints, we previously identified a shift towards older and more severely affected patients with consecutive higher numbers of admissions to escalated care during the pandemic [ 7 ]. While we did not observe such disproportionate changes in demographics or stroke characteristics, we found a significant difference in admission modes: while overall fewer patients presented to the hospital during the COVID epoch in 2020, the vast majority of those who did arrived by ambulance.…”

mentioning

confidence: 99%

Decreased admissions and change in arrival mode in patients with cerebrovascular events during the first surge of the COVID-19 pandemic

Hoyer

Weber

Sandikci

et al. 2020

Neurol. Res. Pract.

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Background and purpose Investigating clinical characteristics of patients presenting with cerebrovascular events during the pandemic may provide valuable insight into further understanding the phenomenon of decreased stroke admissions during the COVID-19 pandemic. Method Data of patients presenting with a cerebrovascular event to the emergency department during weeks 12–17/2020 were compared to data from the respective weeks in 2019. Results A significant reduction in the number of admissions by 35.9% (p = 0.005) was observed during the COVID-19 epoch. In addition, significantly more patients arrived by ambulance during the COVID-19 epoch (2019: 75.7%, 2020: 94.2%; p = 0.001). Conclusion Our data may have implications as to how campaigns raising awareness for serious medical conditions in the context of the pandemic should be framed.

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Epidemiologische Untersuchung zu möglichen Auswirkungen öffentlicher Kommunikation im Rahmen der COVID-19-Pandemie auf Notfallvorstellungen von Kopfschmerzpatient*innen

Wittayer,

Sandikci,

Ebert

et al. 2023

Gesundheitswesen

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ZusammenfassungKopfschmerzerkrankungen sind häufige Vorstellungsgründe in der Notaufnahme. Wichtig ist hierbei das Erkennen von potenziell gefährlichen Grunderkrankungen, die mit Kopfschmerzen einhergehen. Wir hypothetisierten, dass es zu einer verstärkten Inanspruchnahme der Notaufnahme aufgrund von Kopfschmerzen kam, nachdem die venöse Thrombose zerebraler Sinus, die oft starke Kopfschmerzen bedingt, als seltene Nebenwirkung der Impfung mit Adenovirus-Vektor-basierten Coronavirus-disease 2019 (COVID-19)-Impfstoffen identifiziert und durch das Paul-Ehrlich-Institut öffentlich kommuniziert worden war. Es erfolgte eine retrospektive Analyse der Daten von Patient*innen mit der Abschlussdiagnose einer primären Kopfschmerzerkrankung oder eines nicht näher spezifizierten Kopfschmerzes der Jahre 2019 und 2021, die sich in der Zentralen Notaufnahme der Universitätsmedizin Mannheim vorgestellt hatten. Auf Grundlage der Daten des vom Bundesministerium für Gesundheit herausgegebenen Impfdashboards wurden die Kalenderwochen 14–30 und 47–48 einerseits sowie 1–13 und 31–46 andererseits in eine Variable „Impfepoche“ kategorisiert (14–30, 47–48: hohe Impfaktivität bei bundesweit≥3 Mio. Impfungen/Woche; 1–13, 31–46: niedrige Impfaktivität bei bundesweit<3 Mio. Impfungen/Woche). Abhängige Variable waren die Anzahl der Vorstellungen. Mittels Poisson-Regression wurde geprüft, ob die Häufigkeit der Ereignisse sich als Funktion des Jahres (2019, 2021), der Impfepoche (niedrig, hoch) und einer Interaktion von Jahr und Epoche – letzteres den Effekt der Impfaktivität vor dem Hintergrund der Pandemie reflektierend und als Inzidenzratenverhältnis angegeben – darstellt. Im Vergleich zu 2019 ergab sich eine über 70%ige Zunahme von Vorstellungen aufgrund von Kopfschmerzen in Phasen hoher Impfaktivität im Jahr 2021 (p<0.001; 95%-Konfidenzintervall 1.272–2.316), 25% der Vorstellungen im Jahr 2021 erfolgten aufgrund einer patient*innenseitig vermuteten Assoziation mit stattgehabter Impfung. Neben anderen Faktoren, welche im Rahmen der Pandemiesituation zu einer veränderten Vorstellungssituation führen, mögen die öffentliche Informationsverbreitung und dadurch induzierte Noceboeffekte Ursachen der in unserer Analyse zutage gekommenen Unterschiede in den Vorstellungszahlen zwischen den Epochen mit unterschiedlich starker Impfaktivität sein. Dies illustriert die Auswirkungen der Kommunikation medizinischer Fakten und Informationen in Krisensituationen auf praktische Aspekte notfallmedizinischer Versorgung.

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<p>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</p>

Cited by 4 publications

References 33 publications

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Decreased admissions and change in arrival mode in patients with cerebrovascular events during the first surge of the COVID-19 pandemic

Epidemiologische Untersuchung zu möglichen Auswirkungen öffentlicher Kommunikation im Rahmen der COVID-19-Pandemie auf Notfallvorstellungen von Kopfschmerzpatient*innen

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