How Covid-19 impacted on trauma in a national neurosurgical centre

Irish Neurology Association 57th Annual Meeting, Virtual, 27-28 May 2021

The final session of the INA’s 57th Annual Meeting was on the topic of neurosurgery and stroke. The final speaker in this session was Dr Jack Horan, Senior House Officer, Beaumont Hospital, who presented a study on ‘The Impact of Covid-19 on trauma in a National Neurosurgical Centre’ on behalf of the team at Beaumont.

This retrospective study covered all trauma referrals and admissions during the first part of the Covid-19 restrictions in Ireland, from the 1 March – 31 of May 2020 – and compared them with the same period in 2019. The study looked specifically at the number of referrals by diagnosis and mechanism of injury and the 30-day mortality rates in admitted patients. The secondary outcomes were transfer times, admission to surgery time and ICU admissions.

There was a reduction of 17.1 per cent between 2019 and 2020 in terms of trauma referrals. The daily average of referrals in 2019 was 5.7, while in 2020 it was 4.8. When Dr Horan and his team looked at traumatic brain injury, which is the leading cause of death and disability among young people in high income countries, the incidence of referral dropped from 375 in 2019 to 283 in 2020.

There was a reduction in the number of spinal trauma referrals, during the Covid-19 period of 60 per cent. The most common type of injury are low falls, which are characterised as a fall from a height of below two metres, these account for 60 per cent of referrals generally. This finding reflects the findings of the major trauma audit which the team carried out in 2018, which found that 58 per cent of brain trauma occurs after a low fall.

However, during the Covid-19 period, these referrals saw a reduction of 14 per cent. Dr Horan did note that there was no change in the incidence of Alleged Assault and Road Traffic Collision referrals across the period studied. The primary outcome examined by this study, as noted earlier, was the 30-day mortality and this increased from 7.7 per cent in 2019 to 15.6 per cent in 2020. A finding of the study, which Dr Horan noted was surprising, was that the transfer and surgery times were decreased during the Covid-19 period.

Overall, Dr Horan explained that there was a 17.1 per cent decrease in referrals between 2019 and 2020. 10 per cent of referrals were accounted for by traumatic brain injury. Although the admission rate dropped by 17.9 per cent, the ICU admissions saw an increase, from 51.3 per cent in 2019 to 69.7 per cent in 2020. The length of stay in 2020 was, on average five days longer. None of the patients tested positive for Covid-19.