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Involuntary ambulatory triage during the COVID-19 pandemic - A neurosurgical perspective
Harald Krenzlin1, Christoph Bettag2, Veit Rohde2
1Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland Palatinate, Germany.
Insights
During COVID-19 lockdowns, emergency neurosurgical admissions significantly decreased. This unexpected reduction in critical care access highlights the need to ensure all patients receive necessary hospital treatment.
Area of Science:
- Neurosurgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic created unprecedented global healthcare challenges.
- Lockdowns led to resource reallocation and restricted hospital admissions to emergencies.
- This study investigates the impact on neurosurgical patient access to care.
Purpose of the Study:
- To analyze the impact of COVID-19 lockdown measures on hospital admissions for neurosurgical conditions.
- To quantify changes in emergency neurosurgical admissions during the lockdown period.
- To understand the decision-making effects on patient access to hospital treatment.
Main Methods:
- Retrospective cohort study of two German neurosurgical services.
- Analysis of hospital admissions during the nationwide lockdown (March 16-April 16, 2020).
- Comparison with admissions data from 2018 and 2019.
Main Results:
- Overall emergency admissions decreased by 44.7%.
- Cranial emergency admissions dropped by 48.1%.
- Spinal emergency admissions decreased by 30.9%.
Conclusions:
- COVID-19 lockdowns dramatically reduced emergency neurosurgical admissions, beyond elective procedure postponements.
- The reasons for this decline are complex and likely unintended.
- Future efforts must ensure continued hospital access for all patients requiring neurosurgical care.
Background:
The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under "lockdown" conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions.
Methods:
This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16th to April 16th, 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies.
Results:
A total of 243 in-patients were treated between March 16th and April 16th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Göttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%.
Conclusion:
Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in morbidity and mortality are still unpredictable, efforts should be made to accommodate all patients in need of hospital access going forward.
