Critically Ill Neurologic Patients During The COVID-19 Pandemic: A Short Communication

Shah, Vishank Arun; Nalleballe, Krishna; Onteddu, Sanjeeva Reddy

PURPOSE: We aimed to evaluate utilization of inpatient hospital and critical care services in critically ill neurologic patients during the COVID-19 pandemic. We hypothesized based on prior observations in 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 compared to similar time-frame in previous years. We also compared the prevalence and 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. 11917 patients, p<0.0001) and a 34.4% reduction compared to 2018 (8568 vs. 13064 patients, p<0.0001). However, there was no statistically significant difference in mortality (2020: 12.2 vs. 2019: 12.4% ; p=0.7; vs. 2018: 12.6%; p=0.62) 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<0.0001, p=0.0001), 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.