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

Abstract

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.