176 Changes in Brain and Spine Trauma Volume, Management, and Outcomes During the COVID-19 Pandemic in Kigali, Rwanda

Abstract

INTRODUCTION: During the COVID-19 pandemic, lockdown policies, movement restriction, and healthcare resource reallocation impacted traumatic brain injury (TBI) and spinal cord injury (SCI) incidence and treatment patterns. However, these trends have not been characterized in the Sub-Saharan Africa setting. 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, excluding a cessation in research activities from March-May due to pandemic restrictions. Study personnel collected data on demographics, injury characteristics, treatments, and clinical outcomes. Differences in patients admitted before (1/27/20-3/22/20) and during (6/1/20-6/28/20) the COVID-19 pandemic were queried using chi-squared and Mann-Whitney tests. RESULTS: 216 neurosurgical trauma patients at CHUK were included for analysis. 83.8% had TBI, 8.3% had SCI, and 7.9% had both TBI and SCI. The mean age was 34.1 (standard deviation = 12.5) and most patients were male (77.8%). Patients predominantly experienced injury following road traffic accident (65.7%). Weekly volumes for TBI (mean = 16.5 vs. 17.1, P = 0.819) and SCI (mean = 2.0 vs. 3.4, P = 0.086) did not change during the COVID-19 period. Patients during this period had lower Glasgow Coma Scale scores (mean = 13.8 vs. 14.3, P = 0.068) and Kampala Trauma Scores (mean = 14.0 vs. 14.3, P = 0.083) at admission, both denoting higher injury severity, but these differences did not reach significance. Patients admitted during the pandemic were significantly more likely to undergo brain CT imaging (65.7% vs. 50.0%, P = 0.030), with higher rates of documented hemorrhage, contusion, or fracture (35.7% vs. 19.2%, P = 0.008). Craniotomy rates also significantly increased during the pandemic (22.7% vs. 11.4%, P = 0.036). ED discharge (44.8% vs. 53.7%, P = 0.231) and mortality rates (2.9% vs. 4.9%, P = 0.505) did not change during this period. CONCLUSION: Neurosurgical trauma volume did not change significantly at CHUK during the COVID-19 pandemic, but presenting patients had higher injury severity and craniotomy rates. To the best of the authors’ knowledge, this is the first such TBI and SCI analysis conducted in Africa.