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

Abstract

Background We assess the impact of lockdown in Germany due to the COVID-19 pandemic on the incidence and outcome of neurotrauma emergencies at a tertiary medical center.

Methods All neurosurgical emergencies from March 16, 2020 (first lockdown in Germany) to January 31, 2021 were included and compared with 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). The 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 1,056 days (p = 0.34).

Conclusion The reasons for the increase in the number of neurotrauma emergencies were the following: (1) many surrounding smaller care providers were canceled 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 strengthen 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.

Keywords

neurotrauma - tertiary trauma center - SARS-CoV2 pandemic - neurosurgical emergencies

Ethical Approval

The study was performed according to the guidelines of good clinical practice in accordance with the WMA principles of the Declaration of Helsinki.

Publication History

Received: 27 March 2022

Accepted: 21 July 2022

Accepted Manuscript online:
28 July 2022

Article published online:
01 June 2023

• References

• 1 Robert Koch Institut. Epidemioogischer Stechbrief zu SARS-CoV-2 und COVID-19. Accessed January 14, 2021, at: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html
• 2 Möckel M, Bachmann U, Behringer W, Pfäfflin F, Stegemann MS. How emergency departments prepare for virus disease outbreaks like COVID-19. Eur J Emerg Med 2020; 27 (03) 161-162
• 3 Möckel M, Reiter S, Lindner T, Stagman A. “Triage”: primary assessment of patients in the emergency department: an overview with a systemic review. Med Klin Intensivmed Notf Med 2020; 115 (08) 668-681
• 4 Slagman A, Behringer W, Greiner F. et al; Martin Möckel für das Forum universitäter Notaufnahmen (FUN) und das AKTIN-Notaufnahmeregister. Medizinische Notfälle während der COVID-19-Pandemie. Deutsches Ärtzeblatt 2020; 117 (33–34):545–552 i-iv
• 5 Ruchholtz S, Mand C, Lewan U. et al Regionalisation of trauma care in Germany: the “TraumaNetwork DGU(®)-Project.”. Eur J Trauma Emerg Surg 2012; 38 (01) 11-17
• 6 https://www.destatis.de/DE/Themen/Gesellschaft Umwelt/Bevoelkerung/Bevoelkerungsstand/_inhalt.html#sprg352056
• 7 American College of Emergency Physicians. American College of Emergency Physicians COVID-19. https://www.emergencyphysicians.org/globalassets/emphysicians/all-pdfs/acep-mc-Covid19-april-poll-analysis.pdf Accessed August 19, 2020
• 8 Gärtner C, Walz L, Bauernschmitt E, Ladwig K-H. The causes of prehospital delay in myocardial infarction. Dtsch Arztebl Int 2008; 105 (15) 286-291