Need for ensuring care for neuro-emergencies-lessons learned from the COVID-19 pandemic
Need for ensuring care for neuro-emergencies-lessons learned from the COVID-19 pandemic
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DOI：
10.1007/s00701-020-04437-z
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发表时间：
2020-06-08
影响因子：
2.4
通讯作者：
Vajkoczy, Peter
中科院分区：
文献类型：
--
作者：
Hecht, Nils;Wessels, Lars;Vajkoczy, Peter
背景为了调查危重急症患者是否正在寻求或接受他们所需的医疗护理，我们描述了COVID-19大流行第一阶段期间神经急症患者的护理现实。方法在这项观察性纵向队列研究中，根据神经急症的存在、入院途径、管理和疾病类别，对2019年2月1日至4月15日期间和2019年同期在我科就诊的所有神经外科住院患者进行识别和分类。此外，研究了蛛网膜下腔出血（aSAH）和慢性硬膜下血肿（cSDH）患者的临床病程，代表了严重血管性和半紧急创伤性疾病，这些疾病表现出多种症状。结果：在大流行期间，神经外科急诊在所有神经外科住院患者中的比例保持相似，但通过急诊科就诊的比例高于通过门诊或转诊就诊的比例（*p = 0.009）。所有类型疾病的神经急症总数均显著减少（*p = 0.0007），尤其是血管急症（*p = 0.036），但脊髓急症（*p = 0.007）和脑积水急症（*p = 0.048）也显著减少。尽管症状严重程度相似，但脊柱急症患者在48小时后出现（*p = 0.001）。对于aSAH，病例数量、aSAH级别、动脉瘤定位和治疗方式没有变化，但引人注目的是，患有cSDH的老年患者出现频率较低，症状更严重（*p = 0.046），并且不太可能达到良好的结果（*p = 0.003）与前几年相比，出院时。结论尽管采取了与流行病相关的限制性措施和资源重新分配，但应鼓励神经系统急症患者就诊，无论症状的严重程度如何，因为延迟就诊可能会导致不良结局。因此，尽管对抗COVID-19，保护关键医疗资源仍然至关重要。
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.