Abstract

Background Covid-19 has caused many complications for both the infected and those in need of medical care. This may be due to infection-related prognosis worsening or the patients' avoidance of referring to the hospital for fear of contracting the infection. The decline of acute referral to the ER of many significant conditions with severe results on both the well-being and life-expectancy is a serious concern. To address these concerns, we designed this study to evaluate the recent pandemic's impact on "in-hospital mortality" caused by neurological disorders pre and postpandemic.Methods and material The inclusion criteria were any acute neurological condition and the consent of the patients eligible for our study. The definitions of all assessed conditions and the comorbidities are ICD-10 based. Hypertension and diabetes mellitus, due to their high prevalence, were evaluated separately from other internal comorbidities. The total number of the enrolled patients was 1742, 671 of whom had been during the COVID-19 pandemic, and 1071 had attended the ER during the prepandemic era.Results The overall mortality was significantly higher during the pandemic, and the covid infected had suffered higher mortality rates. (p-value < 0.05)Conclusion During the pandemic, those with minor strokes and other nonlife-threatening ailments had avoided hospital care leading to a significantly higher rate of critical conditions. Increased incidence of strokes and ICHs during the pandemic, too, caused significant increased in-hospital mortality.


Authors

Khoshsirat, Nahid Abbasi;  Qorbani, Mostafa;  Farivar, Ali Mokhtari;  Mohammadpoor Nami, Sahar;  Mohammadian Khonsari, Nami

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  • pre-publication peer review (FINAL ROUND)
    Decision Letter
    2021/05/25

    25-May-2021

    Dear Dr. Mohammadian Khonsari:

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    Author Response
    2021/04/23

    Main points:
    **Actually, in results section, only tables, no clear and detail explanation of results. For example, in table 1, which were higher, which were lower or no changes before and during pandemic need to be added.

    answer:

    Dear reviewer thank you for the comment,
    the results section was expanded and explained thoroughly.

    **It seemed that rates of different kinds of neurological diseases pre and during pandemic are different, p value should be added separately.

    answer:
    Dear reviewer thank you for the comment
    Adding all the neurologic conditions that are grouped in sections such as life-threatening and nonlife-threatening and every P-value separately would would prolix the manuscript and would exceed some of the limitations of the journal, however P-values based on conditions (groups) for the comparison of the two eras, have been added which indicates the significance of the pandemic.

    **Additionally, it is not clear the column meaning in figure 1.

    answer:
    Figure 1 was remade and explained,

    Minor points:
    **“All admission data from March till the end of June of 2019, the pre-pandemic period, and the similar months of 2020, the post pandemic period, were chosen.” Adding the exact starting and ending date for data collection.

    answer:
    The exact starting time was added.

    **In table 1: Underlaying internal condition, should be underlying

    answer:
    Corrections were made.

    additionally figures of "tables and the figures" of the manuscript was uploaded in jpg format upon request.
    some minor changes and editing has been done to ease the readability and comprehension of the manuscript for the reader
    thank you for the comments
    sincerely
    Nami.M



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  • pre-publication peer review (ROUND 1)
    Decision Letter
    2021/03/27

    27-Mar-2021

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    Associate Editor Comments to Author:

    Reviewer(s)' Comments to Author:

    Reviewer: 1

    Comments to the Author
    This paper investigated the effects of the COVID-19 pandemic on in-hospital mortality of neurological diseases, as well as possible affecting factors. I have some suggestions to improve the quality of the paper.

    Main points:
    Actually, in results section, only tables, no clear and detail explanation of results. For example, in table 1, which were higher, which were lower or no changes before and during pandemic need to be added. It seemed that rates of different kinds of neurological diseases pre and during pandemic are different, p value should be added separately.
    Additionally, it is not clear the column meaning in figure 1.

    Minor points:
    “All admission data from March till the end of June of 2019, the pre-pandemic period, and the similar months of 2020, the post pandemic period, were chosen.” Adding the exact starting and ending date for data collection.

    In table 1: Underlaying internal condition, should be underlying

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    Reviewer report
    2021/03/17

    This paper investigated the effects of the COVID-19 pandemic on in-hospital mortality of neurological diseases, as well as possible affecting factors. I have some suggestions to improve the quality of the paper.

    Main points:
    Actually, in results section, only tables, no clear and detail explanation of results. For example, in table 1, which were higher, which were lower or no changes before and during pandemic need to be added. It seemed that rates of different kinds of neurological diseases pre and during pandemic are different, p value should be added separately.
    Additionally, it is not clear the column meaning in figure 1.

    Minor points:
    “All admission data from March till the end of June of 2019, the pre-pandemic period, and the similar months of 2020, the post pandemic period, were chosen.” Adding the exact starting and ending date for data collection.

    In table 1: Underlaying internal condition, should be underlying

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