Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda.
Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda.
复制标题
DOI：
10.1089/neu.2022.0166
复制
发表时间：
2023-03
影响因子：
4.2
通讯作者：
Aluisio, Adam R.
中科院分区：
文献类型：
--
作者：
Tang, Oliver Y.;Uwamahoro, Chantal;Marques, Catalina Gonzalez;Beeman, Aly;Odoom, Enyonam;Ndebwanimana, Vincent;Uwamahoro, Doris;Niyonsaba, Mediatrice;Nzabahimana, Apollinaire;Munyanziza, Silas;Nshuti, Steven;Jarmale, Spandana;Stephen, Andrew H.;Aluisio, Adam R.
关键词：
遏制2019冠状病毒病（COVID-19）传播和卫生保健资源重新分配的国家法规可能影响了神经创伤（包括创伤性脑损伤（TBI）和脊柱创伤）的发病率和治疗，但这些趋势在撒哈拉以南非洲地区尚未得到表征。本研究分析了卢旺达三级医院神经创伤患者在COVID-19大流行之前和期间的流行病学、管理和结局差异。研究地点是卢旺达国家转诊医院基加利大学中心医院（CHUK）。2020年1月27日至2020年6月28日前瞻性入组了前往CHUK急诊科（艾德）就诊的成人损伤患者。研究人员收集了人口统计学、损伤特征、系列神经学检查、治疗和结局的数据。使用卡方和Mann-Whitney U检验评估了COVID-19大流行之前（2020年1月27日至2020年3月21日）和期间（2020年6月1日至2020年6月28日）患者的差异。研究人群包括216名神经创伤患者（83.8%为TBI，8.3%为脊柱创伤，7.9%为两者兼有）。平均年龄为34.1岁（标准差[SD] = 12.5），77.8%为男性。患者主要经历了道路交通事故（RTA; 65.7%）后受伤。研究期间TBI（平均值= 16.5 vs. 17.1，p = 0.819）和脊柱创伤（平均值= 2.0 vs. 3.4，p = 0.086）的每周体积相似。在大流行期间，患者到达时的格拉斯哥昏迷量表（GCS）评分（平均值= 13.8 vs. 14.3，p = 0.068）和坎帕拉创伤评分（KTS;平均值= 14.0 vs. 14.3，p = 0.097）较低，表明损伤严重程度较高，但这些差异仅接近显著性。在大流行期间接受治疗的患者在计算机断层扫描（CT）成像中出血、挫伤或骨折的发生率更高（47.1%比26.7%，p = 0.003）和神经功能下降（18.6%比7.5%，p = 0.016）。COVID-19期间住院率也显著增加（54.6% vs. 39.9%，p = 0.048）。在大流行期间，开颅手术率翻了一番（25.7%对13.7%，p = 0.003），但死亡率没有变化（5.5%对5.7%，p = 0.944）。在COVID-19大流行期间，CHUK的神经创伤量保持不变，但就诊患者的损伤紧急程度和开颅手术率较高。这些发现可能会在卢旺达和类似环境中的大流行条件下提供信息。
National regulations to curb the coronavirus disease 2019 (COVID-19) transmission and health care 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. The study setting was the Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda's national referral hospital. Adult injury patients presenting to the CHUK Emergency Department (ED) were prospectively enrolled from January 27, 2020 to June 28, 2020. Study personnel collected data on demographics, injury characteristics, serial neurological examinations, treatment, and outcomes. Differences in patients before (January 27, 2020 to March 21, 2020) and during (June 1, 2020 to June 28, 2020) the COVID-19 pandemic were assessed using chi-squared and Mann-Whitney U tests. The study population included 216 patients with neurotrauma (83.8% TBI, 8.3% spine trauma, and 7.9% with both). Mean age was 34.1 years (standard deviation [SD] = 12.5) and 77.8% were male. Patients predominantly experienced injury following a road traffic accident (RTA; 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 Glasgow Coma Scale (GCS) scores (mean = 13.8 vs. 14.3, p = 0.068) and Kampala Trauma Scores (KTS; 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 computed tomography (CT) imaging (47.1% vs. 26.7%, p = 0.003) and neurological 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). 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.
登录
查看更多内容
影响因子：
8.3
作者：
Lord AS;Gilmore E;Choi HA;Mayer SA;VISTA-ICH Collaboration
通讯作者：
VISTA-ICH Collaboration
卢旺达受伤患者死亡率预测评分的表现。
DOI：
10.5811/westjem.2020.10.48434
发表时间：
2021-01-22
期刊：
The western journal of emergency medicine
影响因子：
--
作者：
Tang OY;Marqués CG;Ndebwanimana V;Uwamahoro C;Uwamahoro D;Lipsman ZW;Naganathan S;Karim N;Nkeshimana M;Levine AC;Stephen A;Aluisio AR
通讯作者：
Aluisio AR
影响因子：
4.4
作者：
King, RW;Plewa, MC;Knotts, FB
通讯作者：
Knotts, FB
DOI：
10.1016/j.afjem.2021.06.002
发表时间：
2021-09
期刊：
African journal of emergency medicine : Revue africaine de la medecine d'urgence
影响因子：
--
作者：
Mahoney SH;Steyn E;Lategan H
通讯作者：
Lategan H
影响因子：
1.3
作者：
Aluisio, Adam R.;Barry, Meagan A.;Levine, Adam C.
通讯作者：
Levine, Adam C.