Lintas Konstantinos, Rohde Stefan, Ellrichmann Gisa, El-Hamalawi Boris, Sarge Robert, Strohmann Thorsten, Müller Oliver
Neurosurgical Department, Dortmund Hospital, Germany.
Radiological and Neuroradiological Department, Dortmund Hospital, Germany.
Clin Neurol Neurosurg. 2022 Sep;220:107370. doi: 10.1016/j.clineuro.2022.107370. Epub 2022 Jul 19.
To assess the impact of the lockdown in Germany due to the SARS-CoV2-pandemic on the incidence and the outcome of neurovascular emergencies at a tertiary medical center.
From March 16th, 2020 (first lockdown in Germany) to January 31st, 2021, all neurosurgical emergencies were included and compared to a longitudinal case-cohort. Cases were descriptively recorded and retrospectively analyzed with respect to incidence and outcome.
All emergencies referred to our tertiary medical center decreased by 10% during the pandemic, whereas, neurosurgical emergencies increased by 18.4% (764 vs. 905 cases). Number of specific non-ischemic neurovascular emergencies increased by 29% (95 vs. 123 cases). The difference was not statistically significant (p = 0.53). Mortality rate increased dramatically by 40% during the pandemic throughout all neurovascular cases. As all included patients were negative PCR-tested for SARS-CoV2 the observed increase is unrelated to the virus infection.
Unexpectedly, according to our data neurovascular emergencies raised in number and severity during the pandemic in Germany at our tertiary referral center. Furthermore, the case fatality increased. Even though our data lack proof of evidence for these findings, we might suggest two possible explanations for the absolute increase in numbers: firstly, patients might have refused to seek medical help while suffering only mild symptoms. Furthermore, as numerous lower-level medical centers restricted admissions, the referral times of patients in need of neurosurgical attention increased. We, therefore, suggest that even in a pandemic situation like the SARS-CoV2/COVID-19, it seems of utmost importance to retain dedicated neurovascular competence in designated centers to care for these emergencies.
评估德国因严重急性呼吸综合征冠状病毒2（SARS-CoV2）大流行实施封锁措施对一家三级医疗中心神经血管急症的发病率及治疗结果的影响。
纳入2020年3月16日（德国首次封锁）至2021年1月31日期间所有神经外科急症病例，并与一个纵向病例队列进行比较。对病例进行描述性记录，并就发病率和治疗结果进行回顾性分析。
在大流行期间，转诊至我们三级医疗中心的所有急症减少了10%，而神经外科急症增加了18.4%（从764例增至905例）。特定非缺血性神经血管急症的数量增加了29%（从95例增至123例）。差异无统计学意义（p = 0.53）。在整个神经血管病例中，大流行期间死亡率急剧上升了40%。由于所有纳入患者的严重急性呼吸综合征冠状病毒2聚合酶链反应检测均为阴性，因此观察到的死亡率上升与病毒感染无关。
出乎意料的是，根据我们的数据，在德国大流行期间，我们的三级转诊中心神经血管急症的数量和严重程度有所增加。此外，病死率也有所上升。尽管我们的数据缺乏这些发现的证据支持，但我们可能对数量绝对增加提出两种可能的解释：首先，患者在仅出现轻微症状时可能拒绝寻求医疗帮助。此外，由于众多基层医疗中心限制收治，需要神经外科治疗的患者转诊时间增加。因此，我们建议，即使在SARS-CoV2/冠状病毒病2019这样的大流行情况下，在指定中心保留专门的神经血管治疗能力以处理这些急症似乎至关重要。
