Department of Neurosurgery, National Institute of Mental Health and Neurosciences Bengaluru, Karnataka, India.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences Bengaluru, Karnataka, India.
World Neurosurg. 2021 Apr;148:e197-e208. doi: 10.1016/j.wneu.2020.12.111. Epub 2020 Dec 29.
The novel coronavirus disease 2019 (COVID-19) pandemic has been at its peak for the past 8 months and has affected more than 215 countries around the world. India is now the second most-affected nation with more than 48,000,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation, the number of deaths is almost one third that of the United States and one half that of Brazil. However, there has been no experience published from non-COVID-19-designated hospitals, where the aim is to manage noninfected cases with neurosurgical ailments while keeping the number of infected cases to a minimum.
We analyzed the number of neurosurgical cases (nontrauma) done in the past 5 months (March-July 2020) in our institute, which is the largest neurosurgical center by volume in southern India, and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time.
We operated a total of 630 cases (nontrauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (P = 0.002) reduction in the number of cases operated as compared with the same 5 months in the preceding year. We employed a dual strategy of rapid antigen testing and surgery for cases needing emergency intervention and reverse transcriptase-polymerase chain reaction test for elective cases. The hospital was divided into 3 zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone, and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists.
We present a patient management protocol for non-COVID-19-designated hospitals in high-volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.
新型冠状病毒病 2019（COVID-19）大流行已经持续了 8 个月，影响了全球 215 个以上的国家。印度现在是受影响第二严重的国家，病例超过 4800 万，死亡 79 万。尽管如此，作为一个中低收入国家，其死亡人数几乎是美国的三分之一，是巴西的一半。然而，在非 COVID-19 指定医院还没有发表过经验，其目的是在将感染病例数量降至最低的同时，管理非感染病例的神经外科疾病。
我们分析了过去 5 个月（2020 年 3 月至 7 月）在我们的研究所进行的神经外科病例（非创伤）数量，该研究所是印度南部最大的神经外科中心，并将同期 5 个月的 2019 年和大流行前 5 个月的数量进行了比较。我们还审查了在此期间管理的 COVID-19 感染总病例数。
在这 5 个月中，我们共进行了 630 例（非创伤）手术，其中有 9 例 COVID-19 感染病例在此期间进行了手术。与前一年同期相比，手术病例数量减少了 57%（P = 0.002）。我们采取了快速抗原检测和手术的双重策略来处理需要紧急干预的病例，以及逆转录聚合酶链反应检测来处理择期病例。根据感染程度，医院被分为 3 个区域（红色、橙色和绿色），彼此之间的互动最小。为每个区域指定了单独的团队，因此，即使没有肺病/医学专家，我们也能够有效地管理感染病例。
我们提出了一种针对高容量中心非 COVID-19 指定医院的患者管理方案，并证明了其有效性。严格分区、有针对性的检测和有效的分诊有助于在大流行期间进行管理。
