Johnson Reid A, Eaton Anne, Tignanelli Christopher J, Carrabre Kailey J, Gerges Christina, Yang George L, Hemmila Mark R, Ngwenya Laura B, Wright James M, Parr Ann M
1University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota.
2Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota.
J Neurosurg. 2022 Jul 26;138(2):465-475. doi: 10.3171/2022.5.JNS22244. Print 2023 Feb 1.
The authors' objective was to investigate the impact of the global COVID-19 pandemic on hospital presentation and process of care for the treatment of traumatic brain injuries (TBIs). Improved understanding of these effects will inform sociopolitical and hospital policies in response to future pandemics.
The Michigan Trauma Quality Improvement Program (MTQIP) database, which contains data from 36 level I and II trauma centers in Michigan and Minnesota, was queried to identify patients who sustained TBI on the basis of head/neck Abbreviated Injury Scale (AIS) codes during the periods of March 13 through July 2 of 2017-2019 (pre-COVID-19 period) and March 13, 2020, through July 2, 2020 (COVID-19 period). Analyses were performed to detect differences in incidence, patient characteristics, injury severity, and outcomes.
There was an 18% decrease in the rate of encounters with TBI in the first 8 weeks (March 13 through May 7), followed by a 16% increase during the last 8 weeks (May 8 through July 2), of our COVID-19 period compared with the pre-COVID-19 period. Cumulatively, there was no difference in the rates of encounters with TBI between the COVID-19 and pre-COVID-19 periods. Severity of TBI, as measured with maximum AIS score for the head/neck region and Glasgow Coma Scale score, was also similar between periods. During the COVID-19 period, a greater proportion of patients with TBI presented more than a day after sustaining their injuries (p = 0.046). COVID-19 was also associated with a doubling in the decubitus ulcer rate from 1.0% to 2.1% (p = 0.002) and change in the distribution of discharge status (p = 0.01). Multivariable analysis showed no differences in odds of death/hospice discharge, intensive care unit stay of at least a day, or need for a ventilator for at least a day between the COVID-19 and pre-COVID-19 periods.
During the early months of the COVID-19 pandemic, the number of patients who presented with TBI was initially lower than in the years 2017-2019 prior to the pandemic. However, there was a subsequent increase in the rate of encounters with TBI, resulting in overall similar rates of TBI between March 13 through July 2 during the COVID-19 period and during the pre-COVID-19 period. The COVID-19 cohort was also associated with negative impacts on time to presentation, rate of decubitus ulcers, and discharge with supervision. Policies in response to future pandemics must consider the resources necessary to care for patients with TBI.
作者的目的是调查全球新冠疫情对创伤性脑损伤（TBI）患者的医院就诊情况及治疗过程的影响。更好地了解这些影响将为应对未来疫情的社会政治和医院政策提供参考。
查询密歇根创伤质量改进项目（MTQIP）数据库，该数据库包含密歇根州和明尼苏达州36家一级和二级创伤中心的数据，以识别在2017 - 2019年3月13日至7月2日（新冠疫情前时期）以及2020年3月13日至7月2日（新冠疫情时期）期间，根据头/颈简略损伤量表（AIS）编码确诊为TBI的患者。进行分析以检测发病率、患者特征、损伤严重程度和治疗结果的差异。
与新冠疫情前时期相比，在我们的新冠疫情时期，前8周（3月13日至5月7日）TBI就诊率下降了18%，随后8周（5月8日至7月2日）上升了16%。累计来看，新冠疫情时期和新冠疫情前时期的TBI就诊率没有差异。用头/颈区域的最高AIS评分和格拉斯哥昏迷量表评分衡量的TBI严重程度在两个时期也相似。在新冠疫情时期，更大比例的TBI患者在受伤一天后才就诊（p = 0.046）。新冠疫情还与褥疮发生率从1.0%翻倍至2.1%相关（p = 0.002）以及出院状态分布的变化相关（p = 0.01）。多变量分析显示，在新冠疫情时期和新冠疫情前时期之间，死亡/临终关怀出院几率、至少入住重症监护病房一天或至少使用呼吸机一天的需求没有差异。
在新冠疫情的最初几个月，出现TBI的患者数量最初低于疫情前的2017 - 2019年。然而，随后TBI就诊率有所上升，导致新冠疫情时期3月13日至7月2日期间与新冠疫情前时期的TBI总体发生率相似。新冠疫情队列还与就诊时间、褥疮发生率以及有监督出院方面的负面影响相关。应对未来疫情的政策必须考虑照顾TBI患者所需的资源。
