Background

To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic.

Methods

In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms.

Results

During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years.

Conclusions

Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.

中文翻译：

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需要确保照顾从COVID-19大流行中汲取的神经紧急情况。

背景

为了调查紧急情况紧急的患者是否正在寻求或接受他们所需要的医疗服务，我们对在COVID-19大流行第一阶段出现神经紧急情况的患者的护理现状进行了描述。

方法

在这项纵向观察性队列研究中，我们根据神经紧急情况的存在，对在2月1日至4月15日期间COVID-19大流行期间和2019年同期向我们科室提出的所有神经外科收治进行了识别和分类，入院途径，治疗方法和疾病类别。此外，以具有多种症状的严重血管和半紧急创伤状况为代表，对动脉瘤性蛛网膜下腔出血（aSAH）和慢性硬膜下血肿（cSDH）患者的临床病程进行了代表性研究。

结果

在大流行期间，所有神经外科手术入院患者的神经急诊百分比仍然相似，但急诊科提供的比例高于门诊或转诊（* p  = 0.009）。 在所有类型的疾病中，特别是在血管性疾病（* p  = 0.036）中，但在脊髓性疾病（* p  = 0.007）和脑积水（* p  = 0.048）紧急情况下，神经紧急情况的总数明显减少（* p = 0.0007）。脊柱急症患者在48小时后出现（* p = 0.001），尽管症状严重程度相当。对于aSAH，病例数，aSAH分级，动脉瘤定位和治疗方式没有改变，但引人注目的是，老年cSDH患者出现频率较低，症状更严重（* p  = 0.046），并且不太可能获得良好的结果（* p  = 0.003）与往年相比。

结论

尽管采取了与流行病相关的限制性措施并重新分配了资源，但无论症状的严重程度如何，都应鼓励有神经急症的患者出诊，因为推迟出诊可能会导致不良后果。因此，尽管与COVID-19作战，关键医疗资源的保护仍然至关重要。