Neurosurgeons on the frontline of COVID-19: no place for surgery?

Gandía-González, María Luisa; Sáez-Alegre, Miguel; Roda, J.M.

doi:10.1007/s00701-020-04390-x

Cited by 10 publications

(10 citation statements)

References 3 publications

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“…[ 9 , 13 - 17 ] Similar patterns have been reported from across the globe. [ 4 , 10 , 11 , 15 , 17 , 19 - 23 ] The decline in the volume of cases during the ongoing pandemic is not restricted to “non-emergent” cases alone and even “emergent” cases including neurotrauma have been affected. Zoia et al .…”

Section: Discussionmentioning

confidence: 99%

“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

Goyal

Swain

Gupta

et al. 2020

Surgical Neurology International

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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.

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Section: Discussionmentioning

confidence: 99%

“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

Goyal

Swain

Gupta

et al. 2020

Surgical Neurology International

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“…We postulated that the supply of neurosurgical care would be in balance with demand and expectations in December 2019, but that supply would decrease and affect neurosurgical care during the pandemic. Several guidelines and recommendations have been recently published on how to manage the pandemic and possible shortage of resources [4,11,15,22]. The guidance comprises prioritization by postponing non-urgent cases, triaging of cases to use resources effectively and optimally meet individual medical needs, and, finally, rationing of cases: the process of selection of who will not be treated to optimally meet a medical need.…”

Section: Survey Of Practice During Pandemic As Reflected By Changesmentioning

confidence: 99%

“…Headache, disturbance of consciousness, olfactory nerve dysfunction, and seizures have been reported among the symptoms of the disease. Subsequently, there is evidence of misdiagnoses when non-Covid-19-related symptoms of neurosurgical disease were mistakenly evaluated as Covid-19 symptoms, leading to patient's and doctor's delay [15,25]. Patients and physicians may have been reluctant to occupy hospital beds for fear of getting infected by SARS-CoV-2 [17].…”

Section: Collateral Damagementioning

confidence: 99%

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic

et al. 2020

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.

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“…Against this background, fear of COVID-19 may prevent patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics [2,15]. Further, reallocation measures and triaging of medical services with the purpose to ensure care for a potential surge of COVID-19 patients represent an unprecedented challenge for all specialties that remain committed to medical emergencies that require immediate attention [5,9,10,19]. National and international concerns in this direction have been voiced in the field of cardiology and neurology, where it is feared that patients with acute coronary heart syndrome or cerebral stroke might avoid hospitals and emergency rooms due to social distancing or fear of acquiring COVID-19 [8,11].…”

Section: Introductionmentioning

confidence: 99%

Need for ensuring care for neuro-emergencies—lessons learned from the COVID-19 pandemic

et al. 2020

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Background To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic. Methods In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms. Results During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years. Conclusions Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.

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Neurosurgeons on the frontline of COVID-19: no place for surgery?

Cited by 10 publications

References 3 publications

“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic

Need for ensuring care for neuro-emergencies—lessons learned from the COVID-19 pandemic

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