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Citation
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Tang OY, Uwamahoro C, González Marqués C, Beeman A, Odoom E, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Nzabahimana A, Munyanziza S, Nshuti S, Jarmale S, Stephen A, Aluisio A. J. Neurotrauma 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: National regulations to curb COVID-19 transmission and healthcare resource reallocation may have impacted incidence and treatment for neurotrauma, including traumatic brain injury (TBI) and spinal trauma, but these trends have not been characterized in Sub-Saharan Africa. This study analyzes differences in epidemiology, management, and outcomes preceding and during the COVID-19 pandemic for neurotrauma patients in a Rwandan tertiary hospital.
METHODS: The study setting was Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda's national referral hospital. Adult injury patients presenting to the CHUK Emergency Department were prospectively enrolled from 1/27/20-6/28/20. Study personnel collected data on demographics, injury characteristics, serial neurological examinations, treatment, and outcomes. Differences in patients before (1/27/20-3/22/20) and during (6/1/20-6/28/20) the COVID-19 pandemic were assessed using chi-squared and Mann-Whitney tests.
RESULTS: The study population included 216 neurotrauma patients (83.8% TBI, 8.3% spine trauma, and 7.9% with both). Mean age was 34.1 years (standard deviation=12.5) and 77.8% were male. Patients predominantly experienced injury following road traffic accident (65.7%). Weekly volume for TBI (mean=16.5 vs. 17.1, P=0.819) and spine trauma (mean=2.0 vs. 3.4, P=0.086) was similar between study periods. During the pandemic, patients had lower GCS (mean=13.8 vs. 14.3, P=0.068) and Kampala Trauma Scores (mean=14.0 vs. 14.3, P=0.097) on arrival, denoting higher injury severity, but these differences only approached significance. Patients treated during the pandemic period had higher occurrence of hemorrhage, contusion, or fracture on CT imaging (47.1% vs. 26.7%, P=0.003) and neurologic decline (18.6% vs. 7.5%, P=0.016). Hospitalizations also increased significantly during COVID-19 (54.6% vs. 39.9%, P=0.048). Craniotomy rates doubled during the pandemic period (25.7% vs. 13.7%, P=0.003), but mortality was unchanged (5.5% vs. 5.7%, P=0.944).
CONCLUSIONS: Neurotrauma volume remained unchanged at CHUK during the COVID-19 pandemic, but presenting patients had higher injury acuity and craniotomy rates. These findings may inform care during pandemic conditions in Rwanda and similar settings.
Language: en |