Impact of the COVID-19 outbreak on neurological consultation in an emergency department

The outbreak of the COVID-19 pandemic and restrictive measures applied worldwide led to a reduction in the number of emergency department (ED) visits [1]. While patients with common neurological conditions, such as headache, epilepsy and back pain, used ED to receive rapid treatment prior to the COVID-19 outbreak, fear of infection in hospital seemed to reduce numbers of these ED visits and rather shift the interest of patients to telemedicine [2]. Therefore, we decided to analyse the effect of the COVID-19 pandemic on the number of neurological ED visits during the first wave of the pandemic in a single large neurological referral ED in Kosice, Slovakia, with respect to the specific type of neurological disease. All patients who were referred for neurological consultations (3:30 p.m. to 7:30 a.m. the following day) from 1 March to 31 May 2020 (a COVID-19 period) and the corresponding interval of 1 March to 31 May 2019 (a non-COVID period) were included. Patients were classified based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) principal diagnosis codes for stroke (I60–I69; G45–G46; ischaemic, transitory ischaemic attack, intracerebral and subarachnoid haemorrhage), headache, epilepsy, back pain, vertigo/dizziness, and remaining neurological conditions (G00–G96.9 except G54–55; G40–41; G43–G44; G45–G46; I60–I69). Statistical analyses were performed using IBM SPSS statistic 25 for Windows (SPSS Statistics, IBM Corporation, Armonk, NY). The non-parametric, twosample Mann–Whitney U test was chosen to compare the number of patients for both periods. Differences in age and gender between referrals of individual diagnoses were calculated using the Chi-squared and independent sample T tests. During the non-COVID period (March–May 2019), a total of 727 patients with a mean age of 57.6 ± 19 years (45.4% were men), visited our neurological ED (Table 1). The Covid-19 outbreak lead to a 44.4% decrease in all visits to the neurological ED (404 versus 727; p < 0.001; mean age 60.2 ± 17.7 years (51.3% were men)). The most significant decrease was seen in patients presenting with back pain (− 57.2%; p < 0.001), epilepsy (− 57.6%; p < 0.001) and “remaining neurological diseases” (− 45.8%; p < 0.001). We did not identify any significant differences for referrals of any group of disorders in terms of gender or age between the non-COVID and COVID-19 period. In terms of the trend over time of total ED visits (Fig. 1), we did observe a gradual decrease in ED visits, from 36 patients/week at the beginning of March 2020 to 15 patients/ week at the end of March 2020. Since then, there has been a slight increase in ED neurological visits, with a stable number of visits until the end of April (24–29 per week). Upon first release of restrictive measures, we observed a gradual increase in ED visits, with a peak at the end of May, when the number of visits returned to that of the non-COVID period. Based on our results, we can claim that the COVID-19 pandemic had an impact on the number of acute neurological ED consultations. Previous evidence showed that the number of general ED consultations was reduced during the first wave of the COVID-19 pandemic, and the authors suggest that the decline in ED visits can be attributed to mandatory social distancing [1]. The decline in stroke-related events in our ED was less significant (− 8.2%; p = 0.283) than those thus far reported from some other countries [3], which can be potentially explained both by the early start of the national media campaign “Do not stay at home with stroke” and also by the lower incidence of COVID-19 positive patients compared to other countries at that time; thus, * Milan Maretta milan.maretta@upjs.sk