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Karmali S, Saxena S, Richards O, Thompson W, McFaull SR, Pike I. What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury. Front Public Health 2024; 12:1385452. [PMID: 38887259 PMCID: PMC11180821 DOI: 10.3389/fpubh.2024.1385452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. Objective A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Methods Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. Results The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Implications Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.
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Affiliation(s)
- Shazya Karmali
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | | | | | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Jagtiani P, Young T, Ahmed W, Devarajan A, Hickman ZL, Jones S. Prevalence of Acute Alcohol Use in Traumatic Brain Injury Patients During the COVID-19 Pandemic: A Retrospective Analysis From Queens, New York. Cureus 2024; 16:e58928. [PMID: 38800166 PMCID: PMC11122664 DOI: 10.7759/cureus.58928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background This study investigates the impact of New York's relaxed alcohol consumption policies during the coronavirus disease (COVID-19) pandemic on alcohol-related traumatic brain injuries (TBIs) among patients admitted to a Level 1 trauma center in Queens. Given the limited research available, this study critically explores the link between public health policies and trauma care. It aims to address a significant gap in the literature and highlight the implications of alcohol regulations during global health emergencies. Methodology A retrospective analysis was conducted among trauma patients from 2019 to 2021. The study period was divided into the following three periods: pre-lockdown (March 7, 2019, to July 31, 2019), lockdown (March 7, 2020, to July 31, 2020), and post-lockdown (March 7, 2021, to July 31, 2021). Data on demographics, injury severity, comorbidities, and outcomes were collected. The study focused on assessing the correlation between New York's alcohol policies and alcohol-related TBI admissions during these periods. Results A total of 1,074 admissions were analyzed. The study found no significant changes in alcohol-positive patients over the full calendar years of 2019, 2020, and 2021 (42.65%, 38.91%, and 31.16% respectively; p = 0.08711). Specifically, during the lockdown period, rates of alcohol-positive TBI patients remained unchanged, despite the relaxed alcohol policies. There was a decrease in alcohol-related TBI admissions in 2021 compared to 2020 during the lockdown period. Conclusions Our study concludes that New York's specific alcohol policies during the COVID-19 pandemic were not correlated with an increase in alcohol-related TBI admissions. Despite the relaxation of alcohol consumption laws, there was no increase in alcohol positivity among TBI patients. The findings suggest a complex relationship between public policies, alcohol use, and trauma during pandemic conditions, indicating that factors other than policy relaxation might influence alcohol-related trauma incidences.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, State University of New York Downstate Health Sciences University, Queens, USA
| | - Tirone Young
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Wasil Ahmed
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alex Devarajan
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zachary L Hickman
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salazar Jones
- Neurological Surgery, Mount Sinai Hospital, New York, USA
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3
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Kläger HE, Nast-Kolb B, Reuter L, Hoffmann F, Juranek S, Bidlingmaier C, Fabri N, Schönberg NKT, Wagner J, Heinen F, Muensterer O, Zeller C, Holler AS, Fröba-Pohl A, Bonfert MV. Trends in Pediatric Mild Traumatic Brain Injury During COVID-19-Related Lockdown-A Single-Center Study. Neuropediatrics 2023; 54:388-396. [PMID: 37127049 DOI: 10.1055/a-2084-2674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND A relevant number of visits to pediatric emergency departments (pED) are associated with mild traumatic brain injury (mTBI). On March 16, 2020, the Bavarian government declared a first full lockdown (LD) related to the coronavirus (COVID-19) pandemic. AIM The aim of the study was to investigate the impact of LD on pediatric mTBI. METHODS Retrospective chart review of presentations to a pED due to mTBI. Study periods covered LD (03/17/2020 through 05/05/2020) and the same time in 2017, 2018, and 2019 as reference period (RP). Comparative analyses were performed by Chi-square or Fisher's exact test. RESULTS Numbers of mTBI cases decreased by half. Age distribution did not differ. A significantly higher proportion of mTBI were related to falls at home (p = 0.001). Further, a higher rate of hospital admissions (p = 0.03), a higher proportion of intensive care unit admissions (p = 0.001), a longer duration of hospital stay (p = 0.02), and a higher rate of intracranial pathologies on neuroimaging were observed during LD (p = 0.007). CONCLUSION The decrease in mTBI presentations is likely due to an absolute decrease in numbers related to the LD measures, combined with a hesitation to present very minor mTBI to the hospital, because of fear of being infected or not to put additional strain on the healthcare system during this healthcare crisis. On the other hand, data of those that presented with mTBI tend to reflect the more severe spectrum of mTBI.
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Affiliation(s)
- Hanna E Kläger
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Benjamin Nast-Kolb
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Lea Reuter
- Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Florian Hoffmann
- Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Sabrina Juranek
- Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Christoph Bidlingmaier
- Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Nicole Fabri
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Nils K T Schönberg
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Johanna Wagner
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Christiane Zeller
- Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anne-Sophie Holler
- Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Alexandra Fröba-Pohl
- Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
- LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
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Certain L, Rostirola JVC, Rostirola GC, Pereira JS, Gonçalves I, Gabrigna KR, Speri FD, Mendes MF, Mottin TS, da Silva I, Rodrigues JA, Schevenin JDC, de Oliveira ABR, Franceli AB, Lisboa CEC, Benites BD. Prehospital blood transfusion in Brazil: results of the first year of implementation in an emergency medical service. Hematol Transfus Cell Ther 2023:S2531-1379(23)02534-8. [PMID: 37865550 DOI: 10.1016/j.htct.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Hemorrhagic shock is the main cause of death in the prehospital environment, which highlights the need to standardize measures aiming at bleeding control and volume replacement in this environment. In Brazil, the first prehospital packed red blood cell transfusion service started in September 2020, in Bragança Paulista, state of São Paulo. OBJECTIVES Describe the trends and characteristics of patients who received prehospital transfusions prior to hospital treatment during the first year of operation. METHODS A retrospective data review was made of all patients who received transfusions from the mobile intensive care unit in Bragança Paulista over one year. RESULTS In this period, 19 patients were transfused. Since activation, the average response time was 20 min. The mean shock indexes before and after blood transfusion were 2.16 and 1.1, respectively. During the course of the 1st year of prehospital transfusions, no blood was wasted and there were no adverse effects. CONCLUSION Introduction of the prehospital packed red blood cell transfusion service was successful, with significant improvement in hemodynamic parameters.
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Affiliation(s)
- Lucas Certain
- Serviço de Atendimento Móvel de Urgência (SAMU - 192), Bragança Paulista, SP, Brazil.
| | | | | | | | | | | | | | | | | | - Israel da Silva
- Serviço de Atendimento Móvel de Urgência (SAMU - 192), Bragança Paulista, SP, Brazil
| | | | | | | | | | | | - Bruno Deltreggia Benites
- Centro de Hematologia e Hemoterapia, Universidade Estadual de Campinas (Hemocentro Unicamp), Campinas, SP, Brazil
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Keleman N, Krasnik R, Mikov A, Dragičević-Cvjetković D. Outcome of early rehabilitation of patients with traumatic brain injury during COVID-19 pandemic in The Republic of Srpska, Bosnia and Herzegovina. Front Neurol 2023; 14:1269564. [PMID: 37840938 PMCID: PMC10569459 DOI: 10.3389/fneur.2023.1269564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period. Materials and methods A retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student t-test and Pearson correlation coefficient were used in statistical analysis. The value (p < 0.05) was used for statistical significance. Results A total of 174 patients with TBI were included in this study. Most of the patients (n = 94) were older than 60, male (n = 125) and the most frequent cause of TBI was falling over (n = 88). About a half (n = 92) had a mild TBI, almost one third of the sample had moderate (n = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), (p < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients. Conclusion The COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.
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Affiliation(s)
- Nataša Keleman
- Clinical Rehabilitation Service, University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Rastislava Krasnik
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Children Habilitation and Rehabilitation, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Mikov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Children Habilitation and Rehabilitation, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Dragana Dragičević-Cvjetković
- Department of Medical Rehabilitation and Balneoclimatology, Institute for Physical Medicine, Rehabilitation and Orthopedic Surgery “Dr Miroslav Zotović”, Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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Leiphart TJ, Leiphart J. The Effect of the COVID-19 Pandemic and Lockdown on Operative Traumatic Brain Injury in Northern Virginia. Cureus 2023; 15:e44746. [PMID: 37680260 PMCID: PMC10480358 DOI: 10.7759/cureus.44746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION COVID-19 is a disease that causes flu-like symptoms and difficulty breathing. Emerging in 2019, the COVID-19 pandemic has affected the entire world through restrictions and lockdowns. Multiple studies have compared the effects of COVID-19 on different types of head trauma, with each one producing different results. The goal of this study was to use state and hospital data to determine whether the COVID-19 pandemic had a significant impact on surgeries for traumatic brain injury (TBI). METHODS Public state data on COVID-19 incidence, sourced from the Virginia Department of Health, was compared to hospital data of 352 patients receiving surgeries for TBI from a single major level-one trauma hospital in Northern Virginia. We used data from the three years before COVID-19 and the two years during the pandemic, using t-tests and Pearson correlation to analyze the data. This is a retrospective case review study on the number and age of patients receiving TBI surgery from March 2017 through February 2022 at Inova Fairfax Hospital in Northern Virginia to determine the impact of the COVID-19 pandemic on these factors. RESULTS When comparing the data, there was a 60% reduction in cases of operative TBI during the peak months of COVID-19 compared to the same months in previous years (p<0.005). Comparing data on the number of Virginia and Northern Virginia COVID-19 cases and data on the age of individuals undergoing TBI surgery four weeks later showed a statistically significant negative correlation (p<0.05) in which the average age of individuals undergoing TBI surgery was lower in the four-week block following a four-week block of increased COVID-19 incidence. CONCLUSION Our findings indicate a correlation between the period of decreased activity from COVID-19 restrictions in Virginia and a decline in both the number of TBI surgeries and the age of individuals undergoing these surgeries.
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Affiliation(s)
- Thaddeus J Leiphart
- Neurosurgery, Inova Health System, Falls Church, USA
- Biology, St. Albans School, Washington, USA
| | - James Leiphart
- Neurosurgery, Inova Health System, Falls Church, USA
- Neurosurgery, University of Virginia School of Medicine, Falls Church, USA
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Spille DC, Kuroczik D, Görlich D, Varghese J, Schwake M, Stummer W, Holling M. Which risk factors significantly influence the outcome of traumatic brain injured patients with alcohol use disorder? Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02346-1. [PMID: 37578515 DOI: 10.1007/s00068-023-02346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Every year, approximately 10 million people worldwide suffer a traumatic brain injury that leads to hospitalization or mortality. Chronic and acute alcohol intoxication increase the risk of developing traumatic brain injury. Alcohol use disorder (AUD) as a predictor of outcome in neurosurgical patients and the definition of risk factors have been sparsely addressed so far. This study aims to improve the understanding of the effects of alcohol use disorder in the context of neurosurgical therapy. METHODS This study included patients admitted to Münster University Hospital with a traumatic brain injury and alcohol use disorder from January 1, 2010, to December 31, 2018. Univariate and multivariate analyses were performed to identify risk factors for a poorer outcome, assessed by the Glasgow Outcome Score. RESULTS Of the 197 patients included, 156 (79%) were male, and 41 (21%) were female, with a median age of 49 years (IQR 38-58 years). In multivariate analyses, age (p < 0.001), the occurrence of a new neurologic deficit (p < 0.001), the development of hydrocephalus (p = 0.005), and CT-graphic midline shift due to intracerebral hemorrhage (p = 0.008) emerged as significant predictors of a worse outcome (GOS 1-3). In addition, the level of blood alcohol concentration correlated significantly with the occurrence of seizures (p = 0.009). CONCLUSIONS Early identification of risk factors in patients with alcohol use disorder and traumatic brain injury is crucial to improve the outcome. In this regard, the occurrence of hydrocephalus or seizures during the inpatient stay should be considered as cause of neurological deterioration in this patient group.
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Affiliation(s)
| | - David Kuroczik
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Julian Varghese
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
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Jäntti S, Ponkilainen V, Kuitunen I, Uimonen M, Luoto T, Mattila VM. Trends in Emergency Department Visits and Surgeries due to Traumatic Brain Injury During the COVID-19 Pandemic in Finland. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:103. [PMID: 36937205 PMCID: PMC10012295 DOI: 10.1007/s42399-023-01437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
We aim to evaluate the changes in the incidence of TBI, trauma craniotomies, and craniectomies during the COVID-19 pandemic in Finland. This retrospective register study was conducted at three Finnish hospitals. We retrieved the numbers of emergency department (ED) visits, inpatient admissions, and trauma craniotomies and craniectomies due to TBI in the adult population from 2017 to 2020.We calculated the incidences per 100 000 inhabitants and compared the year 2020 to the reference years (2017-2019) by incidence rate ratios (IRR) with 95% confidence intervals. The incidence of TBI-related ED visits during the study period compared to the reference years started to decrease in March 2020 (IRR 0.86, CI: 0.73-1.02), and the lowest incidence was seen in April 2020 (IRR 0.83, CI: 0.68-1.01). The incidence of ED visits showed a second decrease in December (IRR 0.80, CI: 0.67-0.96). The incidence of concussion decreased during the national lockdown in March (IRR 0.80, CI 0.66-0.97). The incidence of ED visits due to TBI decreased after the declaration of national lockdown in spring 2020 and showed a second decrease during regional restrictions in December. In addition, the incidence of neurosurgically treated TBI decreased during restaurant restrictions in the spring.
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Affiliation(s)
- Saara Jäntti
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Ilari Kuitunen
- Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
- Department of Pediatrics, Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Teemu Luoto
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Neurosurgery, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL 2000, 33521 Tampere, Finland
- Coxa Joint Replacement Hospital, Niveltie 4, 33520 Tampere, Finland
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Lin V, Lele AV, Fong CT, Jannotta GE, Livesay S, Sharma M, Bonow RH, Town JA, Chou SH, Creutzfeldt CJ, Wahlster S. Impact of COVID-19 on neurocritical care delivery and outcomes in patients with severe acute brain injury - Assessing the initial response in the first US epicenter. J Clin Neurosci 2022; 106:135-140. [PMID: 36308868 PMCID: PMC9556940 DOI: 10.1016/j.jocn.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/06/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
To investigate the pandemic’s impact on critically ill patients with neurological emergencies, we compared care metrics and outcomes of patients with severe acute brain injury (SABI) before and during the initial COVID-19 surge at our institution. We included adult patients with SABI during two separate three-month time periods: 'pre-COVID vs COVID'. We further stratified the COVID cohort to characterize outcomes in patients requiring COVID-19 precautions (Patient Under Investigation, ‘PUI’). The primary endpoint was in-hospital mortality; secondary endpoints included length of stay (LOS), diagnostic studies performed, time to emergent decompressive craniectomies (DCHC), ventilator management, and end-of-life care. We included 394 patients and found the overall number of admissions for SABI declined by 29 % during COVID (pre-COVID n = 231 vs COVID, n = 163). Our primary outcome of mortality and most secondary outcomes were similar between study periods. There were more frequent extubation attempts (72.1 % vs 76 %) and the mean time to extubation was shorter during COVID (55.5 h vs 38.2 h). The ICU LOS (6.10 days vs 4.69 days) and hospital LOS (15.32 days vs 11.74 days) was shorter during COVID. More PUIs died than non-PUIs (51.7 % vs 11.2 %), but when adjusted for markers of illness severity, this was not significant. We demonstrate the ability to maintain a consistent care delivery for patients with SABI during the pandemic at our institution. PUIs represent a population with higher illness severity at risk for delays in care. Multicenter, longitudinal studies are needed to explore the impact of the pandemic on patients with acute neurological emergencies.
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Affiliation(s)
- Victor Lin
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Christine T Fong
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Gemi E Jannotta
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Sarah Livesay
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA; College of Nursing, Rush University, Chicago, IL, USA
| | - Monisha Sharma
- Department of Global Health, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Robert H Bonow
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - James A Town
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sherry H Chou
- Ken and Ruth Davee Dept of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Claire J Creutzfeldt
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Sarah Wahlster
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
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10
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Laufer K, Petek K, Rakusa S, Rakusa M, Rakusa M, Cretnik A. Traumatic Brain Injury during the SARS-CoV-2 Pandemics in Slovenia: A Single Center Study. J Clin Med 2022; 11:jcm11237017. [PMID: 36498592 PMCID: PMC9735714 DOI: 10.3390/jcm11237017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: The SARS-CoV-2 pandemic had a significant impact on the management of traumatic brain injury (TBI). We aimed to compare the clinical characteristics and outcomes of TBI patients before and during the SARS-CoV-2 pandemic.; (2) Methods: We analyzed depicted data from existing medical records on sex, age, mechanism of injury, clinical performance at admission and discharge, neuroimaging, laboratory values at admission, mortality, duration of hospitalization, and referrals after discharge from the traumatology department for all adult patients during the SARS-CoV-2 pandemic and a year before. Variables were compared using the Chi-square or t-test between both groups.; (3) Results: Most patients had mild (n = 477), followed by moderate (11) and severe (11) TBI. Mild TBI was less frequent during the SARS-CoV-2 period (n = 174 vs. n = 303). The incidence of high falls increased during the SARS-CoV-2 period (14.5% vs. 24.7%; p < 0.05) in the group with mild TBI. Patients had similar mean Glasgow Coma Scales (GCS), Glasgow Outcome Scales-Extended (GOSE), and glucose levels at admission before and during the pandemic. Serum ethanol levels were significantly lower during the SARS-CoV-2 period (1.3 ± 0.7 mmol/L vs. 0.7 ± 1.2 mmol/L; p < 0.001). At discharge, the mean GCS was significantly lower (14.7 ± 1.8 vs. 14.1 ± 0.5; p < 0.05) for patients treated during the SARS-CoV-2 period than before the SARS-CoV-2 period. There were no differences in GOSE; (4) Conclusions: our results demonstrated a significant impact of SARS-CoV-2 pandemic on the frequency, mechanism, and consequences of TBI, and may help improve care for our patients.
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Affiliation(s)
- Kevin Laufer
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
- Traumatology Department, Divison of Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Karina Petek
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Sofia Rakusa
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Matej Rakusa
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Correspondence:
| | - Andrej Cretnik
- Traumatology Department, Divison of Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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The Increased Mortality Rate with Lower Incidence of Traumatic Brain Injury during the COVID-19 Pandemic: A National Study. Healthcare (Basel) 2022; 10:healthcare10101954. [PMID: 36292401 PMCID: PMC9601441 DOI: 10.3390/healthcare10101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
Background: the COVID-19 pandemic with the following lockdown strategies have affected virtually all aspects of everyday life. Health services all over the world faced the crisis on an unprecedented scale, hampering timely care delivery. The present study was designed to assess the impact of the COVID-19 outbreak on the incidence and treatment of traumatic brain injuries in Poland. Methods: the data on hospital admissions with traumatic brain injuries as the primary diagnosis were extracted from the National Health Fund of Poland. For the purpose of this study, the search was limited to four relevant diagnosis-related groups. The overall in-house mortality was calculated. Results: there were 115,200 hospitalizations due to traumatic brain injury identified in the database. Overall, in comparison with the average of six prior years, in 2020 the volume of patients with traumatic brain injury dropped by 24.68% while the in-house mortality rate was increased by 26.75%. Conclusions: the COVID-19 pandemic with the resulting lockdown caused a radical reduction in human mobility. It had a profound impact on the incidence of traumatic brain injury, which dropped significantly. At the same time, the mortality rate increased drastically.
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12
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Weber C, Werner D, Thorsen K, Søreide K. Health Care Implications of the COVID-19 Pandemic for Patients with Severe Traumatic Brain Injury-A Nationwide, Observational Cohort Study. World Neurosurg 2022; 165:e452-e456. [PMID: 35728788 PMCID: PMC9212910 DOI: 10.1016/j.wneu.2022.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Containment measures during the coronavirus disease of 2019 (COVID-19) pandemic have resulted in a substantial reduction in treatment of injury. The effect of the COVID-19 pandemic on the epidemiology and mortality of severe traumatic brain injury on a national, population-based level is unknown. METHODS Data on all patients with severe traumatic brain injury between 2017 and 2020 were retrieved from the National Trauma Registry of Norway. The study cohort was derived from the pandemic period (March 12 to December 31, 2020) and the control cohort from the prepandemic years 2017 to 2019. The outcome measures were 30-day mortality, in-hospital mortality, and discharge destination. RESULTS This study included 522 trauma patients with severe traumatic brain injury, 387 (74.1%) in the prepandemic and 135 (25.9%) in the pandemic period. Length of stay increased significantly during the pandemic period (4 vs. 3 days; P = 0.014). The 30-day mortality rate was 39% (n = 149) in the prepandemic versus 38% (n = 52) pandemic period (P = 0.998). In-hospital mortality was 33% (n = 128) in the prepandemic versus 33% (n = 44) in the pandemic period (P = 0.920). There were no statistically significant differences in discharge destination besides the number of patients discharged to home in the pandemic period (P = 0.003). When adjusted for clinical relevant factors such as age, gender, and head injury severity, the mortality outcomes did not change during the pandemic period. CONCLUSIONS The containment and lockdown measures during the COVID-19 pandemic in Norway did not affect the number of patients or mortality of patients with severe traumatic brain injury.
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Affiliation(s)
- Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway,To whom correspondence should be addressed: Clemens Weber, M.D., Ph.D
| | - David Werner
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
| | - Kenneth Thorsen
- Section for Traumatology, Stavanger University Hospital, Stavanger, Norway,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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13
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Reallocation of Hospital Resources During COVID-19 Pandemic and Effect on Trauma Outcomes in a Resource-Limited Setting. World J Surg 2022; 46:2036-2044. [PMID: 35754058 PMCID: PMC9244557 DOI: 10.1007/s00268-022-06636-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/07/2022]
Abstract
Background The COVID-19 pandemic has caused unprecedented disruptions to surgical care worldwide, particularly in low-resource countries. We sought to characterize the association between pre-and intra-pandemic trauma clinical outcomes at a busy tertiary hospital in Malawi. Methods We analyzed trauma patients that presented to Kamuzu Central Hospital in Lilongwe, Malawi, from 2011 through July 2021. Burn patients were excluded. We compared patients based on whether they presented before or during the pandemic (defined as starting March 11, 2020, the date of the official WHO designation). We used logistic regression modeling to estimate the adjusted odds ratio of death based on presentation. Results A total of 137,867 patients presented during the study period, with 13,526 patients during the pandemic. During the pandemic, patients were more likely to be older (mean 28 vs. 25 years, p < 0.001), male (79 vs. 74%, p < 0.001), and suffer a traumatic brain injury (TBI) as their primary injury (9.7 vs. 4.9%, p < 0.001). Crude trauma-associated mortality was higher during the pandemic at 3.7% vs. 2.1% (p < 0.001). The odds ratio of mortality during the pandemic compared to pre-pandemic presentation was 1.28 (95% CI 1.06, 1.53) adjusted for age, sex, initial AVPU score, transfer status, injury type, and mechanism. Conclusions During the pandemic, adjusted trauma-associated mortality significantly increased at a tertiary trauma center in a low-resource setting despite decreasing patient volume. Further research is urgently needed to prepare for future pandemics. Potential targets for improvement include improving pre-hospital care and transportation, planning for intensive care utilization, and addressing nursing shortages.
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14
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Damara FA, Muchamad GR, Anton A, Ramdhani AN, Channel IC, Faried A. Epidemiological Pattern of Traumatic Brain Injury in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 161:e698-e709. [PMID: 35227924 PMCID: PMC8881220 DOI: 10.1016/j.wneu.2022.02.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022]
Abstract
Background Although the incidence of traumatic brain injury (TBI) has decreased since the beginning of the coronavirus disease 2019 (COVID-19) pandemic and severe acute respiratory syndrome coronavirus 2 is still evolving, the number of TBI cases has still greatly increased in multiple countries. In the present systematic review and meta-analysis, we evaluated the epidemiological characteristics of patients with TBI before and during the COVID-19 pandemic. Methods We conducted a systematic literature search of original studies, short reports, and research letters from databases on studies that contained data about the severity, mortality, presence of neurological deficits, radiological diagnosis, cause of injury, and type of management of TBI during a specified period within the pandemic compared with before the pandemic. Results A total of 18,490 subjects from 13 studies were included in the present study. The results of the meta-analysis showed a higher TBI mortality rate during the COVID-19 pandemic in the low-to-middle income countries (odds ratio, 1.65; 95% confidence interval, 1.12–2.41; P < 0.05; I2 = 40.8%; P = 0.18). The proportion of subdural hemorrhage was decreased, and the proportion of subarachnoid hemorrhage was increased in low- to middle-income and high-income countries, respectively. The proportion of assaults as the cause of TBI had increased during the pandemic (odds ratio, 1.40; 95% confidence interval, 1.06–1.86; P = 0.02; I2 = 20.8%; P = 0.28). We did not find any significant differences in the incidence of surgical intervention for TBI during the pandemic. Conclusions Our results have indicated that during the COVID-19 pandemic, the TBI mortality rate had increased in low- to middle-income countries. The rate of assault as the cause of TBI had also increased during the pandemic.
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Affiliation(s)
- Fachreza Aryo Damara
- Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Galih Ricci Muchamad
- Department of Medicine, Faculty of Medicine, Universitas Diponegoro - Kariadi General Hospital, Semarang, Indonesia
| | - Anton Anton
- Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Alfya Nandika Ramdhani
- Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ivan Christian Channel
- Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
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Lester A, Leach P, Zaben M. The Impact of the COVID-19 Pandemic on Traumatic Brain Injury Management: Lessons Learned Over the First Year. World Neurosurg 2021; 156:28-32. [PMID: 34530146 PMCID: PMC8435471 DOI: 10.1016/j.wneu.2021.09.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had widespread consequences on health care systems around the world. It resulted in extensive changes to the referral patterns, management, and rehabilitation of surgical conditions. We aimed to evaluate the effect the COVID-19 pandemic has had on traumatic brain injury (TBI) specifically. We reviewed the literature published on COVID-19 and TBI referrals, management, and rehabilitation. Significant changes were seen in the referral patterns of TBIs worldwide, explained by changes in societal behaviors and changes in the mechanism of injury. Implementation of strict infection control measures and COVID-19 screening was commonplace, with some reporting changes to operating room protocols. TBI was more likely to be conservatively managed. Rehabilitation services were restricted, with a greater shift towards telemedicine to provide rehabilitative therapy remotely.
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Affiliation(s)
- Aled Lester
- School of Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Paul Leach
- Department of Neurosurgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Cardiff, United Kingdom; Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, United Kingdom
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16
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Azab MA, Azzam AY, Eraky AM, Sabra M, Hassanein SF. Analyzing outcomes of neurosurgical operations performed before and during the COVID-19 pandemic in Egypt. A matched single-center cohort study. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021; 26:101369. [PMID: 34485093 PMCID: PMC8409057 DOI: 10.1016/j.inat.2021.101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Abstract
Background Since the emergence of the first COVID-19 case in Wuhan, the virus affected several health care systems. Globally, the COVID-19 has a transforming effect on health care provision. Substantial evidence was clear that the global surgical services were impacted. The field of neurosurgery was primarily affected, and most elective surgeries were suspended. There are no current reports from Egypt that describe the mortality outcome of neurosurgical procedures in the context of the pandemic. Methods We performed that study at a large tertiary center in Egypt (Cairo University Hospital). It is a single-center matched cohort study. Results Our results examined about 346 patients earlier during the COVID-19 pandemic. About 46 (13.29%) were unmatched, so we excluded them from the final analysis of the data. About 300 patients' were matched to 304 patients' before the pandemic in 2019. The mortality outcome of neurosurgical interventions was higher during the pandemic. Conclusions Amid the COVID-19 pandemic, the mortality outcome of neurosurgical procedures was higher than on regular days at our center. The anesthesia time was prolonged while the operation time was shortened. We strongly suggest further multicenter studies to assess the effect of COVID-19 on neurosurgical mortality and functional outcome.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, Cairo University Faculty of Medicine, Cairo, Egypt.,Department of Biomedical Sciences, Boise State University, Idaho, USA
| | - Ahmed Y Azzam
- October 6 University Faculty of Medicine, Giza, Egypt
| | - Akram M Eraky
- Department of Neurosurgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Sabra
- Cardiovascular Research Center, Rhode Island Hospital, Providence, RI 02903, USA
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