ABSTRACT

Introduction

Traumatic brain injury (TBI) is amongst the leading causes of morbidity and mortality worldwide. The unprecedented emergence of COVID-19 has mandated neurosurgeons to limit viral spread and spare hospital resources whilst trying to adapt management plans for TBI. We aimed to characterize how this affects decision-making on TBI management and drive strategies to cope with future expected waves.

Methods

Retrospective TBI data collection from a single tertiary referral unit was performed between: 01/04/2019 – 30/06/2019 (‘Pre-Epidemic’) and 01/04/2020 – 30/06/20 (‘Epidemic’). Demographics, mechanism of injury, TBI severity, radiological findings, alcohol/anticoagulants/antiplatelets use, and management decisions were extracted.

Results

646 TBI referrals were received in ‘Pre-Epidemic’ (N = 317) and ‘Epidemic’ (N = 280) groups. There was reduction in RTA-associated TBI (14.8 vs 9.3%; p = .04) and increase in patients on anticoagulants (14.2 vs 23.6%; p = .003) in the ‘Epidemic’ group. Despite similarities between other TBI-associated variables, a significantly greater proportion of patients were managed conservatively in local referring units without neurosurgical services (39.1 vs 56.8%; p < .0001), predominantly constituted by mild TBI.

Conclusion

Despite COVID-19 public health measures, the burden of TBI remains eminent. Increases in local TBI management warrant vigilance from primary healthcare services to meet post-TBI needs in the community.

中文翻译：

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COVID-19 期间神经创伤的管理：未来的单一中心经验和教训

摘要

介绍

创伤性脑损伤 (TBI) 是全球发病率和死亡率的主要原因之一。COVID-19 的空前出现迫使神经外科医生限制病毒传播并节省医院资源，同时努力调整 TBI 的管理计划。我们旨在描述这如何影响 TBI 管理决策并推动应对未来预期波的策略。

方法

在 01/04/2019 – 30/06/2019（“流行前”）和 01/04/2020 – 30/06/20（“流行”）之间从单个三级转诊单位收集回顾性 TBI 数据。提取了人口统计学、损伤机制、TBI 严重程度、放射学发现、酒精/抗凝剂/抗血小板药物的使用和管理决策。

结果

在“流行前”（N = 317）和“流行”（N = 280）组中收到了 646 份 TBI 转诊。在“流行病”组中，RTA 相关 TBI 减少（14.8 对 9.3%；p = .04），抗凝剂患者增加（14.2 对 23.6%；p = .003）。尽管其他 TBI 相关变量之间存在相似性，但在没有神经外科服务的当地转诊单位接受保守治疗的患者比例显着更高（39.1 对 56.8%；p < .0001），主要由轻度 TBI 构成。

结论

尽管采取了 COVID-19 公共卫生措施，但 TBI 的负担仍然突出。当地 TBI 管理的增加保证了初级医疗保健服务的警惕，以满足社区的 TBI 后需求。