Effects of Social Distancing Due to COVID 19 on Trauma Admissions To a US Level I Trauma Center

INTRODUCTION The number and types of trauma cases admitted to an emergency department (ED) affected by many factors (size of the city, location, season, etc.). During times of disasters or war, the number of cases and patterns may differ. We present the demographics of trauma cases admitted to a US level I trauma center before and after the implementation of social distancing guidelines (March 16, 2020) due to the COVID 19 pandemic. METHODS We reviewed all the cases admitted to our level I trauma hospital ED for the period January- mid April 2020. We generated a battery of descriptive statistics to show the trends of case numbers and types over this period. RESULTS A total of 944 cases for the period of Jan-mid Apr 2020, Average age 49 years, with 62% males and 78% whites. The total number of cases was comparable in January and February (262, 261). In March and mid-March to mid-April there was an increase in total number of cases (281, 274), especially during afternoon and evening hours. During the period January- mid April there was a decline in number of cases of motor vehicle accidents (89, 87, 80, 72) and falls (87, 77, 76, 60). There was an increase in motorcycle accidents (6,3,10,16), hanging (0,0,3,3), and gunshot wounds (23, 18, 36, 37). CONCLUSION Trauma admissions to ED affected by several factors, but overall the patterns are stable over time. For the period of January- mid April 2020, the institution of social distancing due to the COVID 19 pandemics did affect the number and types of trauma cases admitted to a level I trauma center.

Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs.

OBJECTIVE: To determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. METHODS: A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs. RESULTS: Across programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive. CONCLUSIONS: This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.

Intracranial hemorrhage in a young COVID-19 patient.

COVID-19 patients are increasingly understood to develop multisystem manifestations, including neurologic involvement. We report the case of a 42-year old COVID-19 positive patient with a fatal intracerebral hemorrhage (ICH). The patient presented with fever and dyspnea, requiring intubation due to medical complications. After prolonged sedation and anticoagulation, the patient suddenly developed bilaterally fixed and dilated pupils, caused by a right-sided intracranial hemorrhage with uncal herniation. The course of this case illustrates the delicate balance between hypercoagulability and coagulation factor depletion; especially in the intubated and sedated patient, in whom regular neurological assessments are impeded. As we expand our understanding of the neurological ramifications of COVID-19, clinicians need to be increasingly aware of the precarious coagulation balance.