{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T21:01:07Z","timestamp":1771707667729,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Charit\u00e9"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*<jats:italic>p<\/jats:italic>\u2009=\u20090.009). The total number of neuro-emergencies was significantly reduced (*<jats:italic>p<\/jats:italic>\u2009=\u20090.0007) across all types of disease, particularly in vascular (*<jats:italic>p<\/jats:italic>\u2009=\u20090.036) but also in spinal (*<jats:italic>p<\/jats:italic>\u2009=\u20090.007) and hydrocephalus (*<jats:italic>p<\/jats:italic>\u2009=\u20090.048) emergencies. Patients with spinal emergencies presented 48\u00a0h later (*<jats:italic>p<\/jats:italic>\u2009=\u20090.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*<jats:italic>p<\/jats:italic>\u2009=\u20090.046), and were less likely to reach favorable outcome (*<jats:italic>p<\/jats:italic>\u2009=\u20090.003) at discharge compared with previous years.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00701-020-04437-z","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T07:05:43Z","timestamp":1591599943000},"page":"1795-1801","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Need for ensuring care for neuro-emergencies\u2014lessons learned from the COVID-19 pandemic"],"prefix":"10.1007","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-649X","authenticated-orcid":false,"given":"Nils","family":"Hecht","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Wessels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Finn-Ove","family":"Werft","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulf C.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Czabanka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,8]]},"reference":[{"issue":"4","key":"4437_CR1","doi-asserted-by":"publisher","first-page":"e19016","DOI":"10.2196\/19016","volume":"22","author":"A Abd-Alrazaq","year":"2020","unstructured":"Abd-Alrazaq A, Alhuwail D, Househ M, Hamdi M, Shah Z (2020) Top concerns of tweeters during the COVID-19 pandemic: infoveillance study. J Med Internet Res 22(4):e19016","journal-title":"J Med Internet Res"},{"issue":"6","key":"4437_CR2","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1007\/s00701-020-04332-7","volume":"162","author":"M Dobran","year":"2020","unstructured":"Dobran M, Paracino R, Iacoangeli M (2020) Letter to the editor by Dobran Mauro, Paracino Riccardo, and Iacoangeli Maurizio regarding \u201cNeurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy.\u201d Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fo. Acta Neurochir 162(6):1223\u20131224","journal-title":"Acta Neurochir"},{"key":"4437_CR3","doi-asserted-by":"publisher","unstructured":"De Filippo O, D\u2019Ascenzo F, Angelini F et al (2020) Reduced rate of hospital admissions for ACS during Covid-19 outbreak in Northern Italy. N Engl J Med. https:\/\/doi.org\/10.1056\/NEJMc2009166","DOI":"10.1056\/NEJMc2009166"},{"key":"4437_CR4","doi-asserted-by":"publisher","unstructured":"Fontanella MM, de Maria L, Zanin L et al (2020) Neurosurgical practice during SARS-CoV-2 pandemic: a worldwide survey. World Neurosurg. https:\/\/doi.org\/10.1016\/j.wneu.2020.04.204","DOI":"10.1016\/j.wneu.2020.04.204"},{"key":"4437_CR5","doi-asserted-by":"publisher","unstructured":"Gand\u00eda-Gonz\u00e1lez ML, S\u00e1ez-Alegre M, Roda JM (2020) Neurosurgeons on the frontline of COVID-19: no place for surgery? Acta Neurochir. https:\/\/doi.org\/10.1007\/s00701-020-04390-x","DOI":"10.1007\/s00701-020-04390-x"},{"key":"4437_CR6","doi-asserted-by":"publisher","unstructured":"Garcia S, Albaghdadi M, Meraj P et al (2020) Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. https:\/\/doi.org\/10.1016\/j.jacc.2020.04.011","DOI":"10.1016\/j.jacc.2020.04.011"},{"issue":"6","key":"4437_CR7","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1007\/s00701-020-04327-4","volume":"162","author":"C Giussani","year":"2020","unstructured":"Giussani C, Sganzerla E, Valvassori L, Alparone M, Citerio G (2020) The response during a pandemic is a blurred vision of the future. Reflections on the Lombardy reorganization of the neurosurgical emergencies during the COVID-19. Acta Neurochir 162(6):1225\u20131226","journal-title":"Acta Neurochir"},{"key":"4437_CR8","unstructured":"Howard J (2020) Covid-19 fears keep people from hospitals, but doctors say call 911 for heart attack and stroke. CNN"},{"key":"4437_CR9","doi-asserted-by":"publisher","unstructured":"Hulsbergen AFC, Eijkholt MM, Balak N et al (2020) Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation. Acta Neurochir. https:\/\/doi.org\/10.1007\/s00701-020-04375-w","DOI":"10.1007\/s00701-020-04375-w"},{"issue":"6","key":"4437_CR10","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s00701-020-04342-5","volume":"162","author":"WC Jean","year":"2020","unstructured":"Jean WC, Ironside NT, Sack KD, Felbaum DR, Syed HR (2020) The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study. Acta Neurochir 162(6):1229\u20131240","journal-title":"Acta Neurochir"},{"key":"4437_CR11","unstructured":"Kolata G (2020) Amid the coronavirus crisis, heart and stroke patients go missing. New York Times"},{"issue":"4","key":"4437_CR12","doi-asserted-by":"publisher","first-page":"e0231808","DOI":"10.1371\/journal.pone.0231808","volume":"15","author":"SM McFadden","year":"2020","unstructured":"McFadden SM, Malik AA, Aguolu OG, Willebrand KS, Omer SB (2020) Perceptions of the adult US population regarding the novel coronavirus outbreak. PLoS One 15(4):e0231808","journal-title":"PLoS One"},{"key":"4437_CR13","doi-asserted-by":"publisher","unstructured":"Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Ohman J, Helen P (2019) The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg. https:\/\/doi.org\/10.3171\/2018.12.JNS183035","DOI":"10.3171\/2018.12.JNS183035"},{"key":"4437_CR14","doi-asserted-by":"publisher","unstructured":"Rodr\u00edguez-Leora O, Cid-\u00c1lvarezd B, Ojedae S et al (2020) Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiolog\u00eda intervencionista en Espa\u00f1a. REC Interv Cardiol. https:\/\/doi.org\/10.24875\/RECIC.M20000120","DOI":"10.24875\/RECIC.M20000120"},{"key":"4437_CR15","doi-asserted-by":"publisher","unstructured":"Tartara F, Cofano F, Zenga F, Boeris D, Garbossa D, Cenzato M (2020) Are we forgetting non-COVID-19-related diseases during lockdown ? Acta Neurochir. https:\/\/doi.org\/10.1007\/s00701-020-04385-8","DOI":"10.1007\/s00701-020-04385-8"},{"issue":"7","key":"4437_CR16","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","volume":"22","author":"J-L Vincent","year":"1996","unstructured":"Vincent J-L, Moreno R, Takala J, Willatts S, De Mendon\u00e7a A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. Intensive Care Med 22(7):707\u2013710","journal-title":"Intensive Care Med"},{"key":"4437_CR17","doi-asserted-by":"publisher","first-page":"104364","DOI":"10.1016\/j.jcv.2020.104364","volume":"127","author":"G Zhang","year":"2020","unstructured":"Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H (2020) Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol 127:104364","journal-title":"J Clin Virol"},{"issue":"8","key":"4437_CR18","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","volume":"382","author":"N Zhu","year":"2020","unstructured":"Zhu N, Zhang D, Wang W et al (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382(8):727\u2013733","journal-title":"N Engl J Med"},{"issue":"6","key":"4437_CR19","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s00701-020-04305-w","volume":"162","author":"C Zoia","year":"2020","unstructured":"Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM (2020) Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir 162(6):1221\u20131222","journal-title":"Acta Neurochir"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-020-04437-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-020-04437-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-020-04437-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:06:12Z","timestamp":1623110772000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-020-04437-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,8]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["4437"],"URL":"https:\/\/doi.org\/10.1007\/s00701-020-04437-z","relation":{},"ISSN":["0001-6268","0942-0940"],"issn-type":[{"value":"0001-6268","type":"print"},{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,8]]},"assertion":[{"value":"20 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee (ethics committee of the Charit\u00e9 University Hospital in Berlin, Germany; EA1\/097\/20) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"For this type of study, formal consent is not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}