Management of neurosurgical patients during coronavirus disease 2019 pandemics: The Ljubljana, Slovenia experience

Abstract

The novel coronavirus disease 2019 (COVID-19) is an emerging disease, caused by severe acute respiratory syndrome coronavirus-2. It bears unique biological characteristics, clinical symptoms and imaging manifestations, therefore presenting an important and urgent threat to global health. As a result, a new public health crisis arose, threatening the world with the spread of the 2019 novel coronavirus. Despite the maximal worldwide public health responses aimed at containing the disease and delaying its spread, many countries have been confronted with a critical care crisis, and even more, countries will almost certainly follow. In Slovenia, the COVID-19 has struck the health system immensely and among all the specialities, neurosurgery has also been experiencing difficulties in the service, not only in regular, elective surgeries but especially during emergencies. The management of these neurosurgical patients has become more difficult than ever. We describe our protocol in the management of neurosurgical patients in the University Medical Centre Ljubljana, Slovenia and how neurosurgical pathology was tackled during the pandemics.

Keywords: Antivirus protocol; Coronavirus disease 2019; Ljubljana; Pandemic; Patient management; neurosurgery.

Figure 1

A schematic representation of the flow of neurosurgical patients at the University medical centre Ljubljana. Patients with different neurosurgical emergencies were admitted to the surgical general emergency department. After initial screening for coronavirus disease 2019 (COVID-19) with rapid antigen test and the rapid transcriptase polymerase chain reaction (RT-PCR) test, the urgent patients were divided into two groups: (1) to those that could not wait; and (2) to those that could wait. (1) Those patients that could not wait were operated on immediately in the COVID-19 operation theatre. The RT-PCR test was done during surgery again. If positive, the patients were further treated in the red zones, including the COVID-19 intensive care units and special ward areas. In case the patients have contacted COVID-19 during the hospital stay, they were transferred to the red areas or discharged home. The patients in contact with COVID-19 and not positive, were transferred to grey areas; and (2) The patients that could wait were addressed according to the COVID-19 RT-PCR test. When negative, they were treated in the green areas and when positive, they were transferred to the red areas. The elective patients were first admitted into grey areas in the neurosurgical department and waited for the RT-PCR test. When positive, they were discharged home. When negative, they were treated in the green areas. PCR: Polymerase chain reaction; COVID: Coronavirus disease; ICU: Intensive care unit.