ABSTRACT
Introduction: The COVID-19 pandemic has led to an increased burden being placed on our health care system. In this study, we aim to expand upon the impact of COVID-19 on a head and neck cancer population by examining the number of patients presenting to a university emergency department with an initial presentation of head and neck cancer during the pandemic and immediately before it. Method(s): A retrospective analysis of medical records of patients presenting to the emergency department (ED) at Baylor University Medical Center (BUMC) who received a diagnosis of head and neck cancer (HNC) either in the ED or in the admission immediately after was performed for a 6-month pre- COVID-19 time period (September 2019-February 2020) and a 6-month post-COVID-19 time period (April 2020-September 2020). Data analysis of patient presentation and final diagnosis was performed. Analysis of total ED encounters at BUMC per month over both time periods was also performed. Result(s): A chart review of 892 patients found 217 HNCrelated admissions in the pre-COVID-19 period and 228 in the post. In the pre-COVID-19 period, 9 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 4.1% of HNC-related admissions. In the post-COVID-19 period, 14 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 6.1% of HNCrelated admissions. In the pre-COVID-19 period, 1.9 per 10,000 ED visits resulted in a diagnosis of HNC. Comparatively, in the post-COVID-19 period, 3.8 per 10,000 ED visits resulted in a diagnosis of HNC. There was a sharp increase in ED-related HNC diagnoses in May of 2020, with 6.9 per 10,000 ED visits resulting in a diagnosis of HNC. Of ED-related HNC diagnoses, 75% made in May of 2020 were stage IV at the time of diagnosis. Conclusion(s): There has been a significant increase in the amount of primary HNC diagnoses made in the ED or upon subsequent admission since the start of the COVID-19 pandemic. HNC diagnosed at ED presentation or upon subsequent admission are more likely to be late stage, highlighting delays in care secondary to the COVID-19 pandemic.
ABSTRACT
Introduction: Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries, and there is an increasing need for intubation and mechanical ventilation currently due to the COVID-19 pandemic. It is important to fill the literature gaps regarding the incidence of laryngeal injury following prolonged intubation due to COVID-19. Method(s): This study is a retrospective review of patients with swallowing, voice, or airway concerns identified by their primary physician or speech-language pathologist who were evaluated using flexible laryngoscopy from August 14, 2020, to August 18, 2021. A total of 25 patients with COVID-19 and 27 patients without COVID-19 were included. Specific injuries evaluated for were edema/erythema, granulation tissue/ ulceration, posterior glottic stenosis, subglottic stenosis, vocal cord immobility, and vocal cord paralysis. Severe lesions were those that caused significant airway obstruction or required operative treatment or tracheostomy dependence. Result(s): Within the COVID-19 group, 80% of patients had laryngeal injury, with 45% of these in the severe category. In the non-COVID-19 group, 62.9% of patients had a laryngeal injury, with 23.5% being severe. Mild injuries were seen in 44% of COVID-19 patients and 48% of non-COVID-19 patients. The most common injury category seen was granulation tissue/ulceration. Patients with severe injuries were intubated for 6 to 39 days (mean 14.8), those with mild injuries were intubated for 0 to 31 days (mean 10.4), and patients with no injuries were intubated for 0 to 34 days (mean 9.53). Conclusion(s): Patients who were intubated for COVID-19 were more likely to have severe clinically significant laryngeal injuries than non-COVID-19 patients, even when they were intubated for similar amounts of time. Interestingly, the incidence of mild injuries was similar between the 2 groups. Based on these results, it may be beneficial to have a lower threshold for performing flexible laryngoscopy on postintubated COVID-19 patients to evaluate for laryngeal injury. This would allow for earlier intervention and, it is hoped, reduction of morbidity.