"Locked up inside home" - Head injury patterns during coronavirus disease of 2019 pandemic

Abstract

Background: As citizens have been forced to stay home during coronavirus disease of 2019 (COVID-19) pandemic, the crisis created unique trends in the neurotrauma patterns with changes in mode, severity, and outcome of head injured patients.

Methods: Details of neurotrauma admissions under the neurosurgery department at our institute since the onset of COVID-19 pandemic in the country were collected retrospectively and compared to the same period last year in terms of demographic profile, mode of injury, GCS at admission, severity of head injury, radiological diagnosis, management (surgical/conservative), and outcome. The patients were studied according to which phase of pandemic they were admitted in - "lockdown" period (March 25 to May 31, 2020) or "unlock" period (June 1 to September 15, 2020).

Results: The number of head injuries decreased by 16.8% during the COVID-19 pandemic. Furthermore, during the lockdown period, the number of admissions was 2.7/week while it was 6.8/week during the "unlock" period. RTA was the mode of injury in 29.6% patients during the lockdown, while during the unlock period, it was 56.9% (P = 0.000). Mild and moderate head injuries decreased by 41% and severe head injuries increased by 156.25% during the COVID-19 pandemic (P = 0.000). The mortality among neurotrauma patients increased from 12.4% to 22.5% during the COVID-19 era (P = 0.009).

Conclusion: We observed a decline in the number of head injury admissions during the pandemic, especially during the lockdown. At the same time, there was increase in the severity of head injuries and associated injuries, resulting in significantly higher mortality in our patients during the ongoing COVID-19 pandemic.

Keywords: Coronavirus disease of 2019; Head injury; Lockdown; Motor vehicle accidents; Neurotrauma; Road traffic accidents; Unlock.

Figure 1:

Protocol for triaging and coronavirus disease of 2019 (COVID-19) testing for neurotrauma patients at our institute during the COVID-19 pandemic.

Figure 2:

Frequency polygon depicting the number of head injury admissions per week in relation to the rising trend of coronavirus disease of 2019 cases in Uttarakhand during the pandemic. During the lockdown period, there were a total of 27 head injury admissions over 10 weeks, thus accounting for 2.7 admissions per week, while during the 15 weeks of “unlock” period, there were a total of 102 head injury admissions, accounting for 6.8 admissions per week. Thus, head injury admissions per week increased to 2.52 times during the “unlock” period.

Figure 3:

Monthly frequency of neurotraumas admissions during the study period (March 25 to September 15, 2020) compared to the same duration in 2019. During the “lockdown” period (March 25 to May 31), there were only 38.8% hospital admissions of head injury patients as compared to the previous year, whereas in the “unlock”’ period (June 1 to September 15), this proportion increased to 117.0% compared to the same duration in the previous year. This change was found to be statistically significant (P < 0.0001).

Figure 4:

Vertical bar graph depicting the severity of head injury in admitted patients during the ongoing coronavirus disease of 2019 (COVID-19) pandemic compared to pre-COVID-19 era. Compared with pre-COVID-19 era, mild, and moderate cases decreased by 41% and severe cases increased by 193.75% during the COVID-19 pandemic. This change was found to be statistically significant (P = 0.000).