key: cord-355271-zynnr776
authors: Agrawal, Amit; Rafael Moscote-Salazar, Luis; Mishra, Rakesh; Shrivastava, Adesh; Rahman, Moshiur
title: Letter to the editor– “Staying Home - Early Changes in Patterns of Neurotrauma in New York City during the COVID-19 Pandemic
date: 2020-08-09
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.08.035
sha: 
doc_id: 355271
cord_uid: zynnr776

nan

We congratulate Lara-Reyna et al. 1 for their timely shared experience with neurotrauma between PRE COVID-19 and during COVID-19. There is a colossal shift in the pattern of practices for neurotrauma management during this COVID-19 pandemic. Additionally, our apparent impression is that there is decrease in the number cases who are requiring neurosurgical interventions for neurotrauma related conditions. This is well supported by the findings of Lara-Reyna et al . 1 We would like to mention that Road Traffic Accidents (RTA) comprises more TBI cases in Low and middle-income countries (LMIC). 2, 3 It is likely that epidemiology in these places will change correspondingly. According to one systematic review, RTA accounted for over 50% of the neurotrauma cases and double than of falls. 4 As the authors have observed, experience from other trauma centres also identifies fall at home as the most common mechanism 5 and thus strategies to prevent falls in the elderly should be devised and implemented. Spinal injury is a more dynamic event than traumatic brain injury and it will be further interesting to explore the paradigm shift in the epidemiology of spinal cord injury (if any). Overall reduction in numbers can be attributed to the restricted outdoor mobility due to government guidelines. 6, 7 Furthermore, comparative reduction in the number of surgeries may be due to overall decrease in neurotrauma cases and also due to DNR (do not resuscitate) strategies in terminally sick patients. 8, 9 The interesting finding from the present study is that the conversion rate to neurosurgical intervention was low and there was an increase in the DNI/DNR status (5.9% from non-COVID to 12.2% in present COVID era). 10 It leaves us with many open questions including whether we were doing over interventions before COVID epidemic or we are doing under intervention during this COVID epidemic. The answer to this question is only possible by injury severity comparison and overall outcome (including mortality and functional outcome). Observations suggest that a significant number of neurotrauma cases are potentially preventable and thus we can save and optimize the use of much needed resources. We also observe that probably the reduction in the incidence in neurotrauma cases (needs more studies and objective to support) is due to restriction of nonessential activities, social distancing, less crowding and restricted public as well as private transportation. In spite of the limitations, the present article provides a thought-provoking overview of the unique epidemiology of neurotrauma and rendered acute care in an epidemic outbreak. This can be good opportunity for all of us to identify possible interventions to continue to reduce the occurrence of neurotrauma at large in the society. References:

Staying Home

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)

Estimating the global incidence of traumatic brain injury

A systematic review of quantitative research on traumatic brain injury in India

Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand

Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month

Lessons learnt from COVID 19: An Italian multicentric epidemiological study of orthopaedic and trauma services

COVID-19-Impact on DNR Orders in the Largest Cancer Center in Jordan

The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)

Staying Home" -Early Changes in Patterns of Neurotrauma in New York City during the COVID-19 Pandemic