Researchers describe negative impact of COVID-19 pandemic on the treatment of TBIs

Researchers affiliated with the Council of State Neurosurgical Societies investigated the impact of the COVID-19 pandemic on the treatment of traumatic brain injuries (TBIs) by evaluating data from the Michigan Trauma Quality Improvement Program (MTQIP). TBIs occurred during the early months of the pandemic at rates similar to those of previous years, and the researchers describe negative impacts on patient care during the first 4 months of the pandemic.

Detailed findings of this study are described in the article "Changes in patterns of traumatic brain injury in the Michigan Trauma Quality Improvement Program database early in the COVID-19 pandemic" by Johnson et al., published today in the Journal of Neurosurgery (https://thejns.org/).

The global COVID-19 pandemic was declared in mid-March 2020, resulting in the mobilization of healthcare resources for high-acuity COVID-19 patients, discontinuation of elective procedures, and stay-at-home orders for the general public. Growing evidence indicates that patients may have delayed seeking care for emergent conditions such as heart attack and stroke, but the trends are less clear for neurological trauma.

In this study, the authors evaluated data from MTQIP, which includes data from 36 level I and II trauma centers in Michigan and Minnesota. Patients with TBI were identified, and those treated during the early months of the COVID-19 pandemic (March 13 through July 2, 2020) were compared with those treated during earlier years (March 13 through July 2 of each year from 2017 to 2019). The number of patients with TBI initially decreased during the first 8 weeks of the pandemic, but this was followed by a distinct increase during the second 8 weeks and ultimately the rates of TBI were similar between the pre–COVID-19 and COVID-19 periods. Although TBI severity and mechanisms of injury were similar between periods, the patients treated during the COVID-19 pandemic were younger, had higher rates of decubitus ulcers and routine discharge, and presented to the hospital later than those treated during the pre–COVID-19 period.

Improved understanding of the indirect effects of the COVID-19 pandemic on patient presentation and treatment for neurological trauma can be used to inform responses to future pandemics. Despite stay-at-home orders, TBIs occurred during the early months of the pandemic at rates similar to those of previous years. The authors emphasize that hospital policies need to acknowledge continued care for patients with TBI during pandemics.

When asked about the study, Dr. Ann M. Parr said, "In our study, we utilized a multicenter trauma database to investigate impacts of the COVID-19 pandemic on the incidence and initial care of patients suffering TBIs. Given the acuity of these injuries and importance of emergent intervention, it is important to understand how the COVID-19 pandemic and associated challenges have impacted this patient population. During the initial 8 weeks of our study period, we identified a decline in rates of presentation for TBI that was followed by an increase of similar magnitude in the latter 8 weeks of our study. It is unclear why there were declines in rates of patients presenting with TBI, but one concern is that these patients continued to suffer TBIs at rates similar to before the pandemic but opted to not seek care in fear of being exposed to COVID-19. Additionally, we show that during our study period overall, rates of presentation for TBI were similar during the pandemic compared with the same interval in 2017–2019. These findings underscore the importance of maintaining access to trauma centers for the care of TBI even amidst the resource-constrained environment brought on by the pandemic and associated staffing and supply chain issues. Interestingly, we found that rates of TBI presentations were increasing at the end of our study period beyond rates seen in 2017–2019. Additional studies are warranted to assess whether this trend continued beyond our study period. Furthermore, we identified increased rates of decubitus ulcers, patients requiring return to the operating room, and alterations in discharge disposition during the pandemic. These changes may reflect reductions in direct patient contact and reduced access to rehabilitation facilities during the pandemic. Given the relatively low rate of patients testing positive for COVID-19 in our cohort, it is important to recognize the impacts of the COVID-19 pandemic on non–COVID-19 care. We hope that our study calls to attention the need for continued funding and maintenance of resources and access to care for acute neurological conditions such as TBI."