COVID-19 impact on consecutive neurological patients admitted to the emergency department

  1. Andrea Pilotto
  2. Alberto Benussi
  3. Ilenia Libri
  4. Stefano Masciocchi
  5. Loris Poli
  6. Enrico Premi
  7. Antonella Alberici
  8. Enrico Baldelli
  9. Sonia Bonacina
  10. Laura Brambilla
  11. Matteo Benini
  12. Salvatore Caratozzolo
  13. Matteo Cortinovis
  14. Angelo Costa
  15. Stefano Cotti Piccinelli
  16. Elisabetta Cottini
  17. Viviana Cristillo
  18. Ilenia Delrio
  19. Massimiliano Filosto
  20. Massimo Gamba
  21. Stefano Gazzina
  22. Nicola Gilberti
  23. Stefano Gipponi
  24. Marcello Giunta
  25. Alberto Imarisio
  26. Paolo Liberini
  27. Martina Locatelli
  28. Francesca Schiano di Cola
  29. Renata Rao
  30. Barbara Risi
  31. Luca Rozzini
  32. Andrea Scalvini
  33. Veronica Vergani
  34. Irene Volonghi
  35. Nicola Zoppi
  36. Barbara Borroni
  37. Mauro Magoni
  38. Matilde Leonardi
  39. Gianluigi Zanusso
  40. Sergio Ferrari
  41. Sara Mariotto
  42. Alessandro Pezzini
  43. Roberto Gasparotti
  44. Ciro Paolillo
  45. Alessandro Padovani
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Abstract

Objective

Aim of this study was to analyse the impact of COVID-19 on clinical and laboratory findings and outcome of neurological patients consecutively admitted to the emergency department (ED) of a tertiary hub center.

Methods

All adult patients consecutively admitted to the ED for neurological manifestations from February 20th through April 30th 2020 at Spedali Civili of Brescia entered the study. Demographic, clinical, and laboratory data were extracted from medical records and compared between patients with and without COVID-19.

Results

Out of 505 consecutively patients evaluated at ED with neurological symptoms, 147 (29.1%) tested positive for SARS-CoV-2. These patients displayed at triage higher values of CRP, AST, ALT, and fibrinogen but not lymphopenia (p<0.05). They were older (73.1 ± 12.4 vs 65.1 ± 18.9 years, p=0.001) had higher frequency of stroke (34.7% vs 29.3%), encephalitis/meningitis (9.5% vs 1.9%) and delirium (16.3% vs 5.0%). Compared to patients without COVID, they were more frequently hospitalized (91.2% vs 69.3%, p<0.0001) and showed higher mortality rates (29.7% vs 1.8%, p<0.0.001) and discharge disability, independently from age.

Conclusions

COVID-19 impacts on clinical presentation of neurological disorders, with higher frequency of stroke, encephalitis and delirium, and was strongly associated with increased hospitalisation, mortality and disability.

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