PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 753-759
DOI: 10.1055/s-0044-1791267
Original Article

The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome

Thunya Norasethada
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Kriengsak Limpastan
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Tanat Vaniyapong
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Wanarak Watcharasaksilp
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Chumpon Jetjumnong
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Chanon Srihagulang
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Thanat Kanthawang
3   Department of Radiology, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Todsapon Praphanuwat
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Withawat Vuthiwong
3   Department of Radiology, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
,
Jirapong Vongsfak 
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
2   Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
3   Department of Radiology, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
› Institutsangaben Funding This research work was partially supported by faculty of Medicine and Chiang Mai University.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes.

Materials and Methods A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID).

Results The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period (p = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group (p < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients (p = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively (p = 0.23).

Conclusions Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.

Keywords

COVID-19 - head injury - severe - fast-track system - neurological outcome - time metrics - traumatic brain injury - pandemic impact

Authors' Contributions

T.N. and J.V. contributed to conceptualization. J.V. performed data collection. J.V., T.N., T.V., K.L., and T.K. performed formal analysis. T.N., J.V., and T.K. contributed to writing the original draft. T.N., K.L., T.V., W.W., C.J., T.P., W.V., C.S., T.K., and J.V. contributed to writing, reviewing, and editing of the manuscript.


Patients' Consent

In accordance with the ethical approval, patient consent was not needed due to the observational nature of the study.




Publikationsverlauf

Artikel online veröffentlicht:
30. September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 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
    CrossrefPubMedSuche in Google Scholar
  • 2 Reza Bagheri S, Abdi A, Benson J. et al. The significant impact of Coronavirus disease 2019 (COVID-19) on in-hospital mortality of elderly patients with moderate to severe traumatic brain injury: a retrospective observational study. J Clin Neurosci 2021; 93: 241-246
    CrossrefPubMedSuche in Google Scholar
  • 3 Abdelgadir J, Smith ER, Punchak M. et al. Epidemiology and characteristics of neurosurgical conditions at Mbarara Regional Referral Hospital. World Neurosurg 2017; 102: 526-532
    CrossrefPubMedSuche in Google Scholar
  • 4 Dewan MC, Rattani A, Gupta S. et al. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018; 130 (04) 1080-1097
    CrossrefPubMedSuche in Google Scholar
  • 5 Eaton J, Hanif AB, Grudziak J, Charles A. Epidemiology, management, and functional outcomes of traumatic brain injury in Sub-Saharan Africa. World Neurosurg 2017; 108: 650-655
    CrossrefPubMedSuche in Google Scholar
  • 6 Karthigeyan M, Gupta SK, Salunke P. et al. Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads. Acta Neurochir (Wien) 2021; 163 (10) 2919-2930
    CrossrefPubMedSuche in Google Scholar
  • 7 Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg 2011; 253 (06) 1178-1183
    CrossrefPubMedSuche in Google Scholar
  • 8 Kheirbek T, Luhrs AR, Marawha J, Stephen AH, Adams CA, Lueckel SN. Time to head computed tomography protocol in traumatic brain injury: a quality improvement metric. R I Med J (2013) 2021; 104 (06) 28-32
    PubMedSuche in Google Scholar
  • 9 Arundon K, Anumas N, Chunthong P, Cheevarungrod A, Phibalsak T, Lim A. Effect of using a head injury fast-track system on reducing the mortality rate among severe head injury patients in Southern Thailand: a retrospective study with historical control. Int J Crit Illn Inj Sci 2020; 10 (04) 177-181
    CrossrefPubMedSuche in Google Scholar
  • 10 Techakosol V. Effectiveness of fast track system development in head injury patients. Srinagarind Medical Journal 2014; 29: 524-529
    Suche in Google Scholar
  • 11 Goyal N, Swain SK, Gupta K, Chaturvedi J, Arora RK, Sharma SK. “Locked up inside home”: head injury patterns during coronavirus disease of 2019 pandemic. Surg Neurol Int 2020; 11: 395
    CrossrefPubMedSuche in Google Scholar
  • 12 Karthigeyan M, Dhandapani S, Salunke P. et al. The collateral fallout of COVID19 lockdown on patients with head injury from north-west India. Acta Neurochir (Wien) 2021; 163 (04) 1053-1060
    CrossrefPubMedSuche in Google Scholar
  • 13 Prawiroharjo P, Pangeran D, Supriawan H. et al. Increasing traumatic brain injury incidence during COVID-19 pandemic in the emergency department of Cipto Mangunkusumo National General Hospital: a national referral hospital in Indonesia. Neurology 2020; 95 (12, suppl 2): S11-S11
    CrossrefPubMedSuche in Google Scholar
  • 14 Carney N, Totten AM, O'Reilly C. et al. Guidelines for the Management of Severe Traumatic Brain Injury. 4th ed.. Palo Alto, CA: Brain Trauma Foundation; 2016
    Suche in Google Scholar
  • 15 Woodward J, Meza S, Richards D. et al. The scope and impact of the COVID-19 pandemic on neuroemergent patient transfers, clinical care and patient outcomes. Front Surg 2022; 9: 914798
    CrossrefPubMedSuche in Google Scholar
  • 16 Chiba H, Lewis M, Benjamin ER. et al. “Safer at home”: the effect of the COVID-19 lockdown on epidemiology, resource utilization, and outcomes at a large urban trauma center. J Trauma Acute Care Surg 2021; 90 (04) 708-713
    CrossrefPubMedSuche in Google Scholar
  • 17 Manivannan S, Sharouf F, Mayo I. et al. Management of neurotrauma during COVID-19: a single centre experience and lessons for the future. Brain Inj 2021; 35 (08) 957-963
    CrossrefPubMedSuche in Google Scholar
  • 18 Suriyawongpaisa P, Thakkinstian A, Rangpueng A, Jiwattanakulpaisarn P, Techakamolsuk P. Disparity in motorcycle helmet use in Thailand. Int J Equity Health 2013; 12: 74
    CrossrefPubMedSuche in Google Scholar
  • 19 Marquez de la Plata CD, Hart T, Hammond FM. et al. Impact of age on long-term recovery from traumatic brain injury. Arch Phys Med Rehabil 2008; 89 (05) 896-903
    CrossrefPubMedSuche in Google Scholar
  • 20 Miller JD, Nader R. Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth. J Neurosurg 2014; 120 (06) 1378-1384
    CrossrefPubMedSuche in Google Scholar
  • 21 Kesinger MR, Nagy LR, Sequeira DJ, Charry JD, Puyana JC, Rubiano AM. A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury 2014; 45 (09) 1350-1354
    CrossrefPubMedSuche in Google Scholar
  • 22 Matsushima K, Inaba K, Siboni S. et al. Emergent operation for isolated severe traumatic brain injury: does time matter?. J Trauma Acute Care Surg 2015; 79 (05) 838-842
    CrossrefPubMedSuche in Google Scholar