“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

Abstract

Background: As citizens have been forced to stay home during coronavirus disease of 2019 (COVID-19) pandemic, the crisis created unique trends in the neurotrauma patterns with changes in mode, severity, and outcome of head injured patients. Methods: Details of neurotrauma admissions under the neurosurgery department at our institute since the onset of COVID-19 pandemic in the country were collected retrospectively and compared to the same period last year in terms of demographic profile, mode of injury, GCS at admission, severity of head injury, radiological diagnosis, management (surgical/conservative), and outcome. The patients were studied according to which phase of pandemic they were admitted in – “lockdown” period (March 25 to May 31, 2020) or “unlock” period (June 1 to September 15, 2020). Results: The number of head injuries decreased by 16.8% during the COVID-19 pandemic. Furthermore, during the lockdown period, the number of admissions was 2.7/week while it was 6.8/week during the “unlock” period. RTA was the mode of injury in 29.6% patients during the lockdown, while during the unlock period, it was 56.9% (P = 0.000). Mild and moderate head injuries decreased by 41% and severe head injuries increased by 156.25% during the COVID-19 pandemic (P = 0.000). The mortality among neurotrauma patients increased from 12.4% to 22.5% during the COVID-19 era (P = 0.009). Conclusion: We observed a decline in the number of head injury admissions during the pandemic, especially during the lockdown. At the same time, there was increase in the severity of head injuries and associated injuries, resulting in significantly higher mortality in our patients during the ongoing COVID-19 pandemic.

Neurotrauma admissions and COVID-19: a National Centre experience

“…Presentation delays have been reported in subarachnoid haemorrhage, cervical epidural abscess with quadriplegia, and paediatric tumour causing oedema and coma [ 23 ]. The observed increase in mortality in our study may partly be due to a delay in presentation of patients due to fear of contracting COVID-19, and other studies with increased mortality suggest this may be a contributor [ 20 , 22 ]. Initial GCS is an independent predictor of neurological outcome and mortality.…”

“…Similarly, in patients admitted to a neurosurgical ICU in Finland with TBI or aneurysmal subarachnoid haemorrhage (SAH), no difference in mortality was seen (in either diagnosis) [ 18 ]. In contrast, a study in India reported a significant increase in neurotrauma mortality during the pandemic and attributes this to more severe injury mechanism and polytrauma [ 20 ]. An alarming trend that has become apparent is the delay in presentation and resulting worse outcomes for time sensitive emergencies such as spinal emergencies [ 11 ].…”

Letter to the Editor Regarding “Impact of COVID-19 on Neurosurgical Training in Southeast Asia”

“…Regarding outpatient services, 16.1% had completely stopped outpatient departments (OPDs), while 42.37% had switched over to telemedicine exclusively and 11.0% were doing both physical OPDs and telemedicine. We have observed reduction in OPD attendance, inpatient volumes, and surgeries performed at our center, 5 , 6 , 7 , 8 , 9 , 10 , 11 and also all over the country 12 during the ongoing pandemic. This concern has been voiced by neurosurgeons around the world.…”

Getting Neurosurgery Services Back on Its Feet: “Learning to Live” with COVID-19

“…In our previous articles, we have raised concerns about the impact of COVID-19 pandemic on non-COVID-19 patients considered to be ” non-emergent .”[ 6 9 10 15 43 44 45 46 47 48 49 50 51 ] If postponed for too long, these patients risk presenting with more advanced diseases at a later stage. In this article, we have presented the response of our institute and neurosurgery department during the ongoing COVID-19 pandemic in an attempt to highlight our attempts to attend to the ” nonemergent ” patients along with COVID-19 and emergent cases.…”