Neurotrauma Emergencies during the SARS-CoV2 Pandemic at a Tertiary Medical Center: Analysis of Incidence and Outcome

Abstract

Objective: To assess the impact of the lockdown in Germany due to the COVID-19-pandemic on the incidence and the outcome of neurotrauma emergencies at a tertiary medical center. Material and Methods: From March 16th, 2020 (first lockdown in Germany) to January 31st, 2021, all neurosurgical emergencies were included and compared to a longitudinal case-cohort. Cases were descriptively recorded and retrospectively analyzed with respect to incidence and outcome. Results: All emergencies defined as polytrauma referred to our center decreased by 10% during the pandemic (n=226), whereas neurosurgical emergencies increased by 18.4% (764 vs. 905 cases). Number of specific neurotrauma emergencies increased by 44.4% (63 vs. 91 cases), yet statistically not significant (p=0.245). The duration of treatment in the intensive care unit (ICU) extended from 621 to 1056 days (p=0.34). Conclusion: Reasons for increasing numbers of neurotrauma emergencies were: 1) many surrounding smaller care providers were cancelled during this time, and 2) there was a lack of free intensive care capacities in other hospitals, urging primarily maximum care providers to deal with more referrals. Both these facts and the prolonged treatment on ICUs strenghten the necessity for maximum care providers to keep ICU capacities for non-COVID patients. Specialized neurosurgical expertise should maintain in tertiary medical centers, even or particularly in exceptional circumstances such as the current pandemic.

Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

“…Probably, ongoing patient referrals in times of reduced ICU capacity and delayed treatment possibilities resulted in patients with an advanced stage of disease being admitted to university hospitals. This aspect was already shown in the first wave of the pandemic in Germany ( 21 , 29 , 30 ), and might explain the increased incidence of donor instability as a reason against utilized donations.…”

“…Potential DBD donors [defined as a patient with a devastating brain injury or lesion whose clinical condition is suspected to fulfill braindeath criteria ( 20 )] are recruited from the cohort of mechanically ventilated ICU-patients with a severe brain damage. The course of the disease does not allow postponement of admission, diagnosis, and therapy, especially since these patients usually cannot decide for themselves whether they will be admitted to a hospital ( 21 ). Reduced ICU capacities during the pandemic may therefore play a rather minor role in the admission of potential DBD donors (pDBD).…”

“…Studies from the first wave of the pandemic in Germany could show reduced admissions of patients with a severe brain damage, e.g., due to stroke ( 24 , 25 ), or neurosurgical emergencies ( 26 – 28 ), presumably reducing the number of pDBD at that time. Especially smaller hospitals had substantially reduced ICU capacities, resulting in more referrals to higher care level hospitals ( 21 ). Patient referrals, delayed admission, and treatment due to reduced ICU capacity potentially worsens outcome in patients with severe brain damage.…”

“…Hospitals of higher care in Germany reported increased mortality rates for aneurysmal subarachnoid hemorrhage and a dramatic increase in neurovascular cases during the first wave of the pandemic ( 29 , 30 ), as well as for in-hospital mortality after acute ischemic stroke ( 24 ). The pre-hospital rescue time for trauma patients was prolonged ( 31 ) and neurotrauma emergencies increased ( 21 ). Therefore, worsened outcome after severe brain damage due to limited treatment capacity could increase the number of pDBD, at least in tertiary care or university hospitals.…”

Subarachnoid hemorrhages and aneurysms during the SARS-CoV2-pandemia at a tertiary medical center – Analysis of incidence and outcome

“…However, a longitudinal case-cohort study, performed at our tertiary medical referral center, showed an increase of 29% in number and severity of non-ischemic neurovascular emergencies (NINE), as well as on the incidence of neurosurgical traumata during the pandemic ( Lintas et al, 2200 ), ( Lintas et al, 2022 ).…”