Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes

Abstract

Objective: The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase.

Methods: This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B).

Results: The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups.

Conclusions: The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.

Keywords: COVID-19; Outcome; Traumatic brain injury.

Figure 1

Schematic diagram of workflow. GCS, Glasgow Coma Scale; H/o, history of.

Figure 2

Algorithm for management of patients with traumatic brain injury during COVID pandemic. B/L, bilateral; BTF, Brain Trauma Foundation; CBC, complete blood count; CRP, C-reactive protein; CVP, central venous pressure; DVT, deep vein thrombosis; GCS, Glasgow Coma Scale; HCQ, hydroxychloroquine; HFNC, high flow nasal cannula; HRCT, high-resolution computed tomography; ICP, intracranial pressure; IL-8, interleukin-8; KFT, kidney function tests; LFT, liver function tests; LMWH, low-molecular-weight heparin; NCCT, noncontrast computed tomography; NIV, noninvasive ventilation ; NRBM, non-rebreather mask; TBI, traumatic brain injury; USG, ultraaonography.

Figure 3

(A) Comparison of length of hospital stay of patients with traumatic brain injury (TBI) in group A with group B. (B) Comparison of length of hospital stay of COVID-positive patients with TBI in group A with matched controls in group B. (C) Comparison of length of hospital stay of COVID-positive patients with TBI in group A with COVID-negative patients with TBI in group A.

Figure 4

Adverse events among patients with traumatic brain injury in group A compared with group B. SSI, surgical site infection; VAP, ventilator-associated pneumonia.

Figure 5

Comparison of outcome of patients with traumatic brain injury in group A with their matched controls in group B.

Figure 6

Odds ratio plot of univariate analysis of factors predicting favorable outcome of patients with traumatic brain injury (TBI) at discharge. CT, computed tomography; ICP, intracranial pressure; OR, operating room; RTA, road traffic accident; SAH, subarachnoid hemorrhage.