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Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage.

ABSTRACT: Background: The COVID-19 pandemic has seriously impacted healthcare systems worldwide. Admissions for various non-COVID-19 emergencies have significantly decreased. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department. Methods: In a retrospective analysis of admissions to the emergency department of the University Hospital Mannheim from January to June 2020 and the corresponding time period in 2019, all patients admitted for either traumatic or non-traumatic intracranial hemorrhage were evaluated. Poisson regression was performed to analyze changes in admission rates as a function of year, epoch (COVID-19-epoch, March to April 2020 and corresponding months 2019; non-COVID-19-epoch, January to February and May to June 2019/2020) and the interaction of year and epoch (reflecting the impact of the pandemic and subsequent lockdown measures). Results: Overall, 320 patients were included in the study. During the COVID-19-epoch, admission rates for spontaneous intracranial hemorrhage decreased significantly by 42.1% (RR 0.579, p = 0.002, 95% confidence interval 0.410-0.818). Likewise, admission rates for traumatic intracranial hemorrhage decreased significantly by 53.7% [RR = 0.463, p < 0.001, 95% confidence interval (CI) 0.358-0.599]. Conclusion: The decrease of spontaneous intracranial hemorrhages may be a consequence of underutilization of the healthcare system whereas decreasing rates of traumatic intracranial hemorrhage admissions may predominantly reflect a decrease in true incidence rates due to lockdown measures with restricted mobility. Raising patient awareness to seek emergency healthcare for acute neurological deficits during lockdown measures is important to ensure appropriate emergency care for patients with intracranial hemorrhage.

SUBMITTER: Abdulazim A

PROVIDER: S-EPMC7530817 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage.

Abdulazim Amr A Ebert Anne A Etminan Nima N Szabo Kristina K Alonso Angelika A

Frontiers in neurology 20200918

<b>Background:</b> The COVID-19 pandemic has seriously impacted healthcare systems worldwide. Admissions for various non-COVID-19 emergencies have significantly decreased. We sought to determine the impact of COVID-19 on admissions for intracranial hemorrhage to a German University Hospital emergency department. <b>Methods:</b> In a retrospective analysis of admissions to the emergency department of the University Hospital Mannheim from January to June 2020 and the corresponding time period in 2 ...[more]

PMID: 33071955

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Project description:Highlights • In our department of neurosurgery, we noticed a higher rate of patients with ruptured aneurysm who had a deteriorated neurological presentation on admission during COVID-19 pandemic (2020 group, n?=?26).• A group control included 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group).• Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher during COVID-19 pandemic (p?=?0.01 and p?=?0.02, respectively).• During COVID-19 pandemic (2020 group), the delayed hospital admission was longer (p?=?0.005). Therefore, vasospasm’s rate on presentation was also higher (p?=?0.04).• In 2020, patients with only sudden headache may have feared immediate hospital admission because of potential COVID-19 contamination.• In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized. Background/objectives The present study aimed at evaluating the impact on the early outcome of patients with ruptured intracranial aneurysms. Methods Our study prospectively included 26 consecutive patients with ruptured intracranial aneurysm managed at our institution in context of COVID-19 pandemic between March 1st, 2020 and April, 26th, 2020 (2020 group). A group control included other 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group). On admission, poor neurological status was defined as WFNS score >3. Severe radiological status was defined by the presence of intracerebral hematoma, or/and acute hydrocephalus requiring further EVD or/and the presence of vasospasm on presentation. Statistical analysis was performed to compare the 2 distinct groups. Results Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher in the 2020 group (p?=?0.01 and p?=?0.02, respectively). The delayed hospital admission was 2.7 days in 2020 group and 0.75 days in 2019 group (p?=?0.005). Therefore, vasospasm’s rate on presentation was also higher in the 2020 group (p?=?0.04). Conclusion To our knowledge, this is one of the first studies demonstrating influence of the COVID-19 pandemic on patients with urgent and severe intracranial aneurysmal disease. In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized.

Project description:BackgroundTo better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital.MethodsElectronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020-2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases.ResultsDuring the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions.ConclusionsReduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.

Project description:BackgroundConsequences of reduced acute coronary syndrome (ACS) admissions during COVID-19 pandemic periods were reported by different countries. However, admissions, treatments, and prognosis of ACS during and after COVID-19 pandemic in Beijing, China was unknown.MethodsInformation on ACS admissions and heart failure (HF) admission were identified from database of Beijing Municipal Health Commission Information Center. Study period was defined as December 1, 2019 to June 30, 2020, and control period was defined as December 1, 2018 to June 30, 2019. Numbers of admission for HF during the control period, the study period, and seven months after study period were compared to evaluate the consequence of changed ACS care during the COVID-19 pandemic.FindingsAdmissions for ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (Non-STEMI), and unstable angina (UAP) reduced by 38·0%, 41·0%, and 63·3% (N = 1953, 1991, 7664 between January 24, 2020 to June 30, 2020 vs. N = 3150, 3373, and 20,868 between January 24, 2019 to June 30, 2019) in study period. Percutaneous coronary intervention performed within 24 h were significantly more frequent during study period in patients with STEMI (37·9% vs. 31·7%, P<0·0001), but significantly less frequent in patients with Non-STEMI (7·9% vs. 9·5%, P = 0·049), and in patients with UAP (1·7% vs. 3·5%, P<0·0001). In-hospital mortality rates in patients with ACS were similar during the study period and the control period (3·1% vs 2·5%, P = 0·174 for STEMI; 2·7% vs 2·3%, P = 0·429 for Non-STEMI; 0·2% vs 0·1%, P = 0·222 for UAP). A fall by 23.9% for HF admissions was also observed during the seven months following the study period than equivalent period in 2019.InterpretationDuring COVID-19 pandemic, ACS admissions reduced significantly in Beijing; however, increase of HF admissions was not observed within seven months post-pandemic period, implying the pandemic didn't deteriorate the short-term prognosis for ACS.Fundingthe National Natural Science Foundation of China (82,103,904), the National Key Research and Development Program of China (Grant number: 2020YFC2004803).

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Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage.

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Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage.

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