Neuroradiological emergency consultations during the first year of the COVID-19 pandemic.

BACKGROUND: Measures taking aim at minimizing the risk of coronavirus transmission and fear of infection may affect decisions to seek care for other medical emergency conditions. The purpose of this analysis was to analyze intermediate-term effects of the COVID-19 pandemic on neuroradiological emergency consultations (NECs). METHODS: We conducted an ambispective study on NEC requests to a university hospital from a teleradiological network covering 13 hospitals in Germany. Weekly NEC rates for prepandemic calendar weeks (CW) 01/2019-09/2020 were compared with rates during first COVID-19 wave (CW 10-20/2020), first loosening of restrictions (CW 21-29/2020), intensified COVID-19 testing (CW 30-39/2020) and second COVID-19 wave (CW 40-53/2020), and contrasted with COVID-19 incidence in Germany. RESULTS: A total of n = 10 810 NECs were analyzed. Prepandemic NEC rates were stable over time (median: 103, IQR: 97-115). Upon the first COVID-19 wave in Germany, NEC rates declined sharply (median: 86, IQR: 69-92; p < 0.001) but recovered within weeks. Changes in NEC rates after first loosening of restrictions (median: 109, IQR: 98-127; p = 0. 188), a phase of intensified testing (median: 111, IQR: 101-114; p = 0.434) and as of a second COVID-19 wave (median: 102, IQR: 94-112; p = 0. 462) were not significant. Likewise, patient age and gender distribution remained constant. CONCLUSION: Upon the first pandemic COVID-19 wave in Germany, NEC rates declined but recovered within weeks. It is unknown whether this recovery reflects improved medical care and test capabilities or an adjustment of the patients' behaviour.

Variability of computed tomography angiography coverage of lung parenchyma in acute stroke.

BACKGROUND: Computed tomography angiography (CTA) of the head and neck during acute ischemic stroke (AIS) usually includes visualization of lung apices. The possibility to evaluate for pulmonary changes, e.g. peripheral ground-glass and consolidative opacities suggestive of coronavirus disease 2019 (COVID-19)-related pneumonia, depends on the area of the lung covered by CTA. METHODS: We performed an analysis of a real-world scenario assessing the variability of lung coverage on CTA in patients presenting with AIS to a comprehensive stroke center (CSC) or to one of eight primary stroke centers (PSC) within a teleradiological network covered by the comprehensive stroke center in 2019. RESULTS: Our final analysis included n = 940 CTA, and in n = 573 (61%) merely lung apices were covered. In 19/940 (2%) of patients no lung tissue was covered by CTA. CTA scanning protocols in the CSC began significantly more frequently at the level of the ascending aorta (CSC: n = 180 (38.2%), PSC: n = 127 (27.1%), p-value < 0.001) and the aortic arch (CSC: n = 140 (29.7%), PSC: n = 83 (17.7%), p-value < 0.001), and by this covered less frequently the lower lobes compared to CTA acquired in one of the PSC. CONCLUSIONS: In our pre-COVID-19 pandemic representative stroke patient cohort, CTA for AIS covered most often only lung apices. In 37% of the patients CTA visualized at least parts of the lower lobes, the lingula or the middle lobe allowing for a more extensive assessment of the lungs.