Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Abstract

We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

Comparison of emergency consultations of patients with neurologic complaints before and during COVID-19 pandemic in a single tertiary hospital in Makati City, Philippines

“…A Korean study, found that dizziness, followed by motor weakness and altered mental status were the top 3 complaints in 2020. 4 Our study also found a significant change on neurologic chief complaints at the ER. Patients complaining of motor weakness increased from 14.1% to 19% in 2020.…”

“…They were also able to conclude that stroke was particularly more common among patients who are 40 year-old and above and metabolic encephalopathy was found among 60 year-old and older patients. 4 In this study, newonset stroke remained more common among male than female before and during the pandemic with almost similar proportions. Interestingly, new onset encephalopathy was more common among female patients before the pandemic but was found more common among male during the pandemic.…”

“…ER admissions were 55%, 41.8% were sent home, while those who were transferred to another hospital were only 1.1%.Their prepandemic data were not available for comparison. 4 The distribution of final ER disposition changed significantly in our study. In 2020, when compared with pre-pandemic data, there were fewer patients who were admitted to regular ward and ICU (74.5%), fewer patients were sent home (13.1%) and fewer patients were transferred to another hospital (0.9%).…”

Comprehensive Assessment of Acute Isolated or Prominent Dysarthria in the Emergency Department: A Neuro-Emergency Expert’s Experience beyond Stroke

“…This 900-bed facility has a regional emergency medical center, as designated by the government, and receives approximately 75,000 ED visits annually. In our neuro-emergency medicine project [ 14 ], a neuro-emergency expert was responsible for the emergency care of patients with neurological symptoms. Through a systematic review of electronic medical records between 1 January 2020 and 31 December 2021, patients aged ≥18 years with neurologic symptoms treated by a neuro-emergency expert in the ED were screened.…”