Hospitalized Patients With COVID-19 Neurological Complications Subject to Worse Outcomes

Edward S. Claflin, MD

A prospective chart review of patients admitted to hospital with COVID-19 between March 4 and May 1, 2020, revealed that those who develop neurological complications experience a significantly longer length of stay, higher frequency of functional decline, higher mortality rate, and more frequent discharge to a subacute rehabilitation facility (all, P <.0001).

Lead author Edward S. Claflin, MD, associate medical director, Inpatient Rehabilitation, director, Stroke Rehabilitation Program, University of Michigan, and colleagues concluded that “the findings of this study are expected to better prepare patients, providers, and health systems for the postacute needs of those with coronavirus disease 2019 and neurological complications.”

A total of 296 patients included in the final analysis were evaluated on primary outcomes such as new functional decline, discharge location, need for outpatient physical/occupational/speech therapy, need for durable medical equipment at discharge, and presence of dysphagia at discharge. For those who survived to hospital discharge, charts were also reviewed to identify and understand functional changes that were impacting the patient at the time of discharge. Of the complete cohort, 81 patients (27.4%) experienced neurological complications.

Statistically significant differences were observed in age (P <.001), length of stay (P <.00001), and proportion of patients transferred from outside hospital (P = .002), with the neuro-COVID group demonstrating older average age, longer lengths of stay, and greater proportion of patients admitted from another hospital. Neuro-COVID patients stayed an average of 22.78 days (standard deviation [SD], 16.07) compared to 10.19 days (SD, 10.11) for regular patients with COVID-19.

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In total, 84.1% (63 of 81) of neuro-COVID patients had new functional decline compared to 32.6% (60 of 215) of those without neurological complications (P <.0001). Investigators did note though that among those with new functional decline, neuro-COVID patients did not require significantly more frequent need for ongoing therapy services at the time of acute hospital discharge (P = .16) or more frequent need for new durable medical equipment (P =.24). There was a significantly greater frequency of new dysphagia among neuro-COVID patients (n = 25; 47.2%) compared to those without neurological complications (n = 7; 11.7%).

In total, 75.8% (163 of 215) of patients with acute COVID-19 were discharged home, a significantly greater amount than the 30.9% (25 of 81) of those with neurological complications. Investigators also documented significantly higher odds of discharge to subacute rehabilitation/skilled nursing facility (P <.0001). Specifically, 25.9% of those with neurological sequelae were discharged to these facilities compared to 8.8% of those without neurological sequelae.

Neurological status during hospitalization did not relate to differences in discharge to acute inpatient rehabilitation, long-term acute care hospital, or hospice (P >.05). Although, neuro-COVID patients were more likely to die before discharge (22.2%) compared with patients who didn’t have neurological sequelae (14.4%; P <.0001).

There have been several studies that have observed the implications of COVID-19 and its effect on those with previous neurological complications, as well as those who developed them after contracting the virus. A 6-month study recently published by investigators from NYU Langone found that more than 90% of patients discharged for COVID-19 experienced abnormalities in functional outcomes, activities of daily living, anxiety, depression, and sleep. Lead author of that study, Jennifer Frontera, MD, has been at the forefront of understanding these associations. In the video below, she described the neurologic implications of COVID-19 infection and what has been previously observed to that point.

REFERENCES

Claflin ES, Daunter AK, Alecia K, et al. Hospitalized patients with COVID-19 and neurological complications experience more frequent decline in functioning and greater rehabilitation needs. Am J Phys Med Rehabil. Published online July 2021. doi: 10.1097/PHM.0000000000001807