Subject(s)
COVID-19 Vaccines , COVID-19/complications , Myasthenia Gravis/complications , SARS-CoV-2 , Triage , Aged , COVID-19/prevention & control , Critical Care/statistics & numerical data , Disease Susceptibility , Electronic Health Records , Female , Hospitalization/statistics & numerical data , Humans , Intubation, Intratracheal/statistics & numerical data , Male , Middle Aged , Myasthenia Gravis/epidemiology , Myasthenia Gravis/immunologyABSTRACT
PURPOSE: We aimed to evaluate utilization of inpatient hospital and critical care services among critically ill neurologic patients during the COVID-19 pandemic. We hypothesized, based on prior observations among ischemic stroke patients, that there would be significant decline in critically ill neurologic patients presenting to hospitals during the pandemic which may impact outcomes. METHODS: We used TriNetX, a large research network, collecting real-time electronic medical records data. We extracted data on utilization of critical care and hospital inpatient services among cohorts of patients with common neurocritical conditions between January-June 2020 and compared it to data from similar time-frames in previous years. We also compared clinical outcomes, comprising need for intubation and 30-day mortality, among these cohorts. RESULTS: We found a 28.1% reduction in intensive care unit (ICU) admissions with critical neurologic illnesses in 2020 when compared to 2019 (8568 vs. 11,917 patients, p â< â0.0001) and a 34.4% reduction compared to 2018 (8568 vs. 13,064 patients, p â< â0.0001). However, there was no statistically significant difference in mortality (2020: 12.2 vs. 2019: 12.4%; p â= â0.7; vs. 2018: 12.6%; p â= â0.62) or intubation rates across the years among patients using critical care services. There was 1% increase in mortality among non-ICU patients with similar diagnoses in 2020 compared to previous years (2020: 3.9% vs. 2019: 2.9% vs. 2018: 3.1%; p â< â0.0001, p â= â0.0001), but no difference in intubation rates. CONCLUSION: There was a significant reduction in hospital and ICU admissions among patients with acute neurologic emergencies in 2020, after onset of COVID-19 pandemic, compared to previous years. While we did not find a significant difference in mortality among patients admitted to the ICU, there was slightly higher mortality among non-ICU patients with same diagnoses in 2020 compared to previous years. Prospective evaluation and further investigation into the reasons for these trends is needed.