Delivery of Neurocritical Care Servicesto Critically Ill Patients with Altered Mental Status Before and During the COVID-19 Pandemic: A Single Center Study

ABSTRACT

Objective: Compare neurocritical care delivery and outcomes in patients with altered mental status before and during the COVID-19 pandemic. Background: Reduced utilization of inpatient radiology and routine diagnostic procedures has been reported during the COVID-19 pandemic. We hypothesized there was a reduction in the use of neurologic diagnostic procedures for patients with altered mental status. Design/Methods: Single-center retrospective study of critically-ill patients (age ≥18 years) at a large academic center in the United States. ICD-10 codes for altered mental status were used to identify eligible patients 339 in pre COVID-19 period (June-December 2019);145 in the first wave (April-July 2020);279 in the second wave (April-July 2020). CPT codes were used to quantify neurocritical care procedures head CTs, brain MRIs, lumbar punctures, and long-term monitoring EEGs. Results: There were no significant differences in gender, race, Comorbidity Index, or length of stay comparing the pre-COVID-19 period to each COVID-19 wave. Patients in the pre-COVID period were older (median age 64 years vs 60 years in each COVID phase;p=0.0001). There was no significant change in the frequency of head CT or MRIs, and long-term EEGs performed in patients with altered mental status across the three periods. The frequency of LPs decreased;8% in the pre-COVID period vs 6% and 4% (p=0.025) in the respective COVID periods. There was no significant difference in in-hospital mortality for patients with altered mental status across the three periods (OR 0.95 [0.78-1.08] p=0.31).Conclusions: In a large academic center the frequency of neurocritical care radiologic procedures and continuous EEG were not significantly impacted by the pandemic. Additional analysis is indicated to determine if the reduction in diagnostic LPs can be explained by differences in etiology of altered mental status across the three periods. Larger studies can determine whether the pandemic has differentially impacted neurocritical care delivery across varying resource settings.