A Characterization of Neurology Consults for Inpatients with SARS-CoV-2 Infection Compared to Other Respiratory Viruses

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for giving me an opportunity to check your article titled "A Characterization of Neurology Consults for Inpatients with SARS-CoV-2 Infection Compared to Other Respiratory Viruses". This theme is interesting for me, but your paper is a restospective study by a chart review from multi center, which may not be an option, but I feel that the scientific basis is lacking unless the background of the patients is examined in more detail. This is because there are many different patient backgrounds that require ICU management in COVID-19, and the severity of the disease varies depending on the patient background. The only backgrounds mentioned in this paper are those listed in table 1, so it is not clear how we should judge these patients. It may not be a one-to-one correspondence that because a patient is critically ill, he or she is more likely to have a neurological abnormality. Even if we are told that there is a difference from other respiratory related viral infections, how can we say that there is a neurological abnormality when the patient background is not very detailed? For the above reasons, I think this paper needs to be reconsidered.

Author Response

Thank you for your comments. 

We thank the reviewer for bringing up these important limitations to our study. Pre-existing conditions have been shown to be important risk factors for severity of acute COVID-19, particularly prior cardiovascular, pulmonary, and endocrine (diabetes mellitus) diseases. These pre-existing conditions also likely play a role in severity of any respiratory illness. Importantly, our study was not aimed at determining causality of the neurologic abnormality in the setting of SARS-CoV-2 infection, but rather identifying rates of neurological diagnoses and comparing that to other respiratory virus populations. Understanding how pre-existing conditions may impact neurological diseases is important but would require a much larger study. We have added this important topic to the limitation paragraph in the discussion section of the revised manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for an intersting and I believe important paper. You have brought to the readers' attention some highly relevant points.

I have made some suggestions within the body of this paper, which I feel makes the publication more readable.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

The English is of a very high quality - however as an Editor I have always tended to try and stick to the simpler language format. I have therefore offered alternatives where I thought they would improve the readability of the paper.

Author Response

We thank Reviewer #2 for their suggestions to improve the readability of our manuscript. Each has been addressed in the revised manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

The study is interesting but some changes need to be made. Below table 1 the acronyms should be reported in full, for example p and ICU; data statistically significant should be highlighted, for example, in bold or with an asterisk. In the "methods" paragraph it would be better to specify the male-female ratio. It should be noted that there is a strong difference between the SARS-CoV-2 group and the non-SARS-CoV-2 Respiratory Virus group.
The bibliography should be expanded. It might be interesting for future studies to consider not only the neurological diagnosis itself, but also more functional and specific aspects in which the two groups could differ, such as the neuropsychological impact that the virus can have, through a standardized assessment. In developmental age for example a study on the impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders, in particular on Emotional/Behavioral Symptoms, showed an increase in internalizing and externalizing symptoms in children emerged and adolescents with neuropsychiatric disorder. It could therefore be verified whether there are changes in behavior and emotional symptoms also in adults and whether these differ compared to the non-SARS-CoV-2 Respiratory Virus group.

Author Response

1. “The study is interesting but some changes need to be made. Below table 1 the acronyms should be reported in full, for example p and ICU; data statistically significant should be highlighted, for example, in bold or with an asterisk.”

Thank you for this suggestion. A definition of each acronym used has been added below Table 1. An asterisk has been added to statistically significant differences in both Tables 1 and 2 as well.

2. In the "methods" paragraph it would be better to specify the male-female ratio. It should be noted that there is a strong difference between the SARS-CoV-2 group and the non-SARS-CoV-2 Respiratory Virus group.

While the sex differences between each cohort were not statistically significant, we agree that this is still important to highlight. Rather than adding this to the Methods section, we have instead added a statement to this effect at the beginning of the Results section where we discuss other key demographic differences between each cohort.

3. “The bibliography should be expanded. It might be interesting for future studies to consider not only the neurological diagnosis itself, but also more functional and specific aspects in which the two groups could differ, such as the neuropsychological impact that the virus can have, through a standardized assessment. In developmental age for example a study on the impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders, in particular on Emotional/Behavioral Symptoms, showed an increase in internalizing and externalizing symptoms in children emerged and adolescents with neuropsychiatric disorder. It could therefore be verified whether there are changes in behavior and emotional symptoms also in adults and whether these differ compared to the non-SARS-CoV-2 Respiratory Virus group.”

 We thank Reviewer #3 for suggestions on subsequent studies and agree on the importance of designing future studies to address these important causal issues. Prospective studies on neuropsychiatric disease related to COVID-19 are needed.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for giving me an opportunity to check your article again. Last time, I picked up some problems for publishing to this journal because there were many considerable points in previous version. According to your responses, I agree with your opinion and meaning to publish. I accepted your opinion for this article. 

Author Response

Thank you for your thoughtful review of our paper.