Author Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

We appreciate these comments on our article.1 We coded toxic-metabolic encephalopathy only in patients off sedation or after an adequate sedation washout, in contrast to the Chicago study,2 which included patients who may have been receiving sedation or had a positive Confusion Assessment Method (CAM). Although sedation-related delirium has been associated with worse outcomes, the implications for long-term neurologic recovery differ based on the underlying etiologies of encephalopathy, which can best be ascertained when eliminating the confounding effect of sedative medications. Because a proportion of patients were too hypoxic for assessment off sedation, we recognize that we may be underestimating the overall prevalence of neurologic injury in the most critically ill patients. Similarly, hospitalized patients are often unable to express neurologic symptoms because of the severity of illness; hence, findings such as headache, anosmia, or dysgeusia are typically underrepresented and their prevalence is better studied in the outpatient setting. Although our cohort was somewhat older than the Chicago group—median age 65 vs 58 years—we agree that the critical surge and strain on resources in NYC likely impacted mortality rates, which were similarly high in other area hospitals during this time frame.3,4 Preventative efforts to stem such surges in hospitalizations—including masking and social distancing—are essential.

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