Hoyer Carolin, Grassl Niklas, Bail Kathrin, Stein Patrick, Ebert Anne, Platten Michael, Szabo Kristina
Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany.
Neuropsychiatr Dis Treat. 2020 Sep 30;16:2221-2227. doi: 10.2147/NDT.S273913. eCollection 2020.
To analyse the characteristics of patients with neurological complaints seeking evaluation in an interdisciplinary emergency department (ED) during the rise of the COVID-19 pandemic in Germany.
In this retrospective study, data on the number of ED presentations due to neurological complaints in weeks 1-15/2020 were collected. In addition, hospital chart data of patients referred for neurological evaluation during weeks 12-15/2020 when the pandemic began impacting on public life in Germany were analysed regarding demographic information, chief complaints, modes of presentation and disposition and ED discharge diagnosis. Both data sets were compared to respective periods from 2017.
During the surge of COVID-19, we found a significant decrease of the total number of neurological ED patients by 47.6%. Comparing weeks 12-15 of 2017 and 2020, we found a decrease in the number of patients of <30 years (p<0.001) and an increase of those 70 years (p<0.001). A higher proportion of patients were admitted to escalated care (p=0.03), and fewer patients were discharged against medical advice (p<0.001). In addition, the ratio of less acute diagnoses (eg, benign headaches) declined significantly.
Our findings suggest that the pandemic has contributed to a - potentially transient - reframing of laypeople's perception of urgency and necessity for emergency presentation. The establishment and promotion of health-care structures and services like telemedical consultations and the creation of safe ED environments will be essential to enable adequate delivery of care in potential future waves of the pandemic.
分析在德国新冠疫情暴发期间，前往跨学科急诊科（ED）寻求评估的有神经系统症状患者的特征。
在这项回顾性研究中，收集了2020年第1 - 15周因神经系统症状到急诊科就诊的人数数据。此外，还分析了2020年第12 - 15周（疫情开始影响德国公众生活时）转诊进行神经学评估的患者的医院病历数据，内容包括人口统计学信息、主要症状、就诊方式、处置情况和急诊科出院诊断。将这两组数据集与2017年的相应时期进行比较。
在新冠疫情高峰期，我们发现神经系统急诊科患者总数显著下降了47.6%。比较2017年和2020年的第12 - 15周，我们发现<30岁患者数量减少（p<0.001），70岁及以上患者数量增加（p<0.001）。更多患者被收治到高级护理病房（p = 0.03），违反医嘱出院的患者减少（p<0.001）。此外，不太紧急的诊断（如良性头痛）比例显著下降。
我们的研究结果表明，疫情导致了外行人对紧急就诊的紧迫性和必要性的认知发生了——可能是暂时的——重新调整。建立和推广远程医疗咨询等医疗保健结构和服务，以及创建安全的急诊科环境，对于在未来可能的疫情浪潮中确保提供充分的医疗服务至关重要。
