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

Abstract

Background & Objective: COVID-19 forced us to develop adaptive ways to the new normal of healthcare delivery. Neurology has one of the most diverse types of patients who require urgent, prolonged and multidisciplinary care. This study aimed to understand the impact of the unprecedented community lockdown among patients with chronic and new onset neurologic conditions on emergency room (ER) utilization in a single tertiary hospital in Makati City, Philippine. Methods: We retrospectively examined all consecutive neurology referrals made at the ER from March to August 2020 and compared them with a control group consisting of all ER neurology referrals during the same months in 2019. Results: There was a 45% decline in the volume of referral to neurology service at the ER during the first 6 months of the lockdown period. There were fewer females who sought emergency neurologic care (p=0.019). The average age of patients increased from 55.5 years (σ=19.9) in 2019 to 59.5 years (σ=18.4) in 2020 (p<0.001). The top three chief neurologic complaints in 2019 were dizziness (17.7%), motor weakness (14.1%), and headache (13.2%). In 2020, the top three neurologic complaints where motor weakness (19.0%), decreased level of consciousness or loss of consciousness (13.2%), and dizziness (11.2%), (p<0.001). The average time from symptom onset to ER admission in 2019 was 5.1 days (σ=23.9) which increased to 8.4 days in 2020(σ=28.1), (p<0.001). The proportion of patients with no co-morbidities at the ER decreased from 27.6% in 2019 to 17.0% in 2020 (p<0.001). Patients with pre-existing cardiovascular diseases, endocrine diseases, pulmonary diseases, renal diseases, cancers, and others have significantly increased (p<0.05). However, the increase in the proportion of patients with pre-existing neurological disorders (p=0.143) was not statistically significant (p>0.05). The only pre-existing neurologic conditions with significantly increased in proportion was stroke (p=0.010). Among new onset neurologic diagnoses, headache and facial pain (p<0.001) and peripheral and other neuropathies (p=0.005) significantly decreased in proportions while proportions of cases with new stroke or vascular pathology (p<0.001) and encephalopathy (p=0.003) have significantly increased. ER dispositions showed a significant (p<0.001) decrease in proportions of patients who were admitted, discharged, and transferred to hospital of choice; while patients who were discharged against medical advice and who died at the ER have significantly increased. Conclusion: The initial six months of community lockdown during COVID-19 pandemic caused a significant change in the characteristics of patients referred to neurology for emergency care. These changes provide us a new perspective on how to better deliver optimal neurologic care to these diverse patients especially during times of pandemic.