Neurotrauma admissions and COVID-19: a National Centre experience.

BACKGROUND: To investigate the impact of COVID-19 on trauma admissions to a National Neurosurgical Centre in Ireland. METHODS: Retrospective analysis of a prospectively maintained database of all trauma admissions to the National Neurosurgical Centre at Beaumont Hospital, Dublin, during the period March 1 to May 31, 2019 and 2020. Primary outcome was 30-day mortality rate. Secondary outcomes included time transfer time, time from admission to time of surgery, and intensive care unit (ICU) admissions. Patients under the age of 16 were excluded. RESULTS: A total of 32 and 39 patients were admitted to the National Neurosurgical Centre following trauma over the 3-month period in 2020 and 2019 respectively, giving a 17.9% reduction in admissions. The 30-day mortality rate increased from 7.7% in 2019 to 15.6% on 2020 (p = 0.45). Mean transfer time was 4 h 58 min in 2019 and 3 h 55 min in 2020 (0.22). Mean time from admission to time of surgery was 9 h 10 min in 2019 and 5 h 37 min in 2020 respectively (p = 0.35). In 2019, 20 patients (51.3%) were admitted to ICU. This increased to 23 patients (69.7%) in 2020 (p = 0.08). CONCLUSIONS: Traumatic brain injury 30-day mortality rates increased during the first COVID-19 lockdown period. Trauma admission rates to ICU remained unchanged despite an overall reduction in trauma admissions. Transfer time, time to surgery, and length of stay were impacted by COVID-19. Despite the challenges COVID-19 has posed, it is important to maintain a fully functioning neurosurgical and neurocritical care service during the pandemic.

The impact of COVID-19 on trauma referrals to a National Neurosurgical Centre.

BACKGROUND: To investigate the impact of COVID-19 on trauma referrals to a National Neurosurgical Centre during the first wave of COVID-19 in Ireland. METHODS: Retrospective analysis of a prospectively maintained database of all trauma referrals to the National Neurosurgical Centre at Beaumont Hospital, Dublin, during the period March 1-May 31, 2019 and 2020. Patient characteristics including age, sex, alcohol use, anticoagulant/antiplatelet use and initial Glasgow Coma Scale (GCS) were recorded. Patients were grouped based on trauma aetiology and diagnosis. RESULTS: There were 527 and 437 trauma referrals in 2019 and 2020 respectively. Overall, there was a 17.1% reduction in trauma referrals between 2019 and 2020. Traumatic brain injury, spinal injury and cranial fractures referrals reduced 25% (375 vs 283), 59% (32 vs 13) and 18% (39 vs 32) respectively from 2019 to 2020. Low-energy falls below 2 m was the most common mechanism of injury and accounted for 60 and 61% of referrals in 2019 and 2020. No reduction in road traffic collision (33 vs 34) and assault (40 vs 40) referrals were observed between years. CONCLUSIONS: COVID-19 has had a significant impact on both the volume and mechanism of trauma referrals to the National Neurosurgical Centre in Ireland, with falls below 2 m the most common mechanism of trauma referral across both years. The workload remains substantial and a fully resourced neurosurgical department is essential in any future COVID-19 waves.

The provision of neuro-oncology and glioma neurosurgery during the SARS-CoV-2 pandemic: a single national tertiary centre experience.

BACKGROUND: The COVID-19 pandemic has resulted in a significant disruption in the provision of healthcare globally. The aim of this study was to assess the implications of the COVID-19 pandemic on the provision of neuro-oncology surgery and comparison with a similar 3-month period in 2019. METHODS: Retrospective review of prospectively curated database of patients requiring neuro-oncology surgery at our tertiary referral centre between 1st March 2020 and 31st May 2020. We also analysed data for the same time period (1st March-31st May) in 2019 for comparison. Number and type of tumours operated on, postoperative morbidity and mortality, COVID-19-related complications and delays in treatment were recorded. RESULTS: During the 3-month periods studied in 2020 and 2019, there were 127 and 139 admissions for neuro-oncological surgery, respectively. Sixty patients underwent surgery for gliomas during the 2020 period vs 56 in the 2019 period. We observed no increase in mean length of time from referral to inter-hospital transfer (mean of 76 h in 2020 vs 93 h in 2019 (p = 0.10)) or in mean length of time from admission to surgery in the acute admissions (2.39 days in 2020 vs 2.89 days in 2019). The postoperative 30-day morbidity and mortality rates were lower in 2020; 8.7% (n = 11) compared with 10.1% (n = 14) in 2019. There was one COVID-19-related death which occurred in a patient with B cell lymphoma with negative preoperative COVID-19 test. CONCLUSION: The provision of neuro-oncological surgery can be safely continued during respiratory illness epidemic or pandemic if a rigorous testing and staffing framework is implemented.