Availability of specialized medical care in cases of severe head injuries during the COVID-19 pandemic

Abstract

Background: The pandemic of COVID-19 caused an overload of national health care systems worldwide. The analyses of the ways the pandemic changed the availability of the medical care provided in emergency situations has been carried out based on cases of craniocerebral trauma treatment.Material and methods: Data for the period of 2019–2020 on each of 85 territorial subjects of the Russian Federation which are contained in forms of the state statistical observation and also data of Federal State Statistics Service on number of the deceased from head injuries (bone fractures of skull and face) in the period of 2019–2020 have been analyzed. For the measurement of medical care availability level we used the ratio of number of hospitalizations to the total number of deaths due to head injury in territorial subjects of the Russian Federation before COVID-19 pandemic (in 2019) and during the pandemic in 2020. The higher the ratio of admissions in the round-the-clock hospitals to total number of lethal cases due to head trauma, the higher the availability of the specialized emergency medical care. At the same time, we recognize that if the person with a severe head injury is brought to the hospital alive the chances to save his life increase.Results: In 2019 approximately half of the patients with cases of head injuries were admitted in the round-the-clock hospital (the ratio is 274.6 thousand cases of hospitalization to 566.6 thousand cases of the head injury – 48.5% of the total number of head injury cases). In 2020 the share of such cases decreased to 43.1% – 207.5 thousand cases of hospitalization to 481.3 thousand cases of head injury in a year total. On an average in territorial subjects of the Russian Federation the ratio coefficient of hospitalizations number to the total number of lethal outcomes due to head injury in 2019 was 11.6 ± 4.3, in 2020 – 8.8 ± 3.3. Feature variation coefficient is 37.5% and 37.6% in 2019 and 2020 respectively which demonstrates its high variability in territorial subjects of the Russian Federation. A share of the lethal outcomes due to a head injury increased from 3.8% in 2019 to 4.5% in 2020 of total number of patients that received this type of trauma, or by 1.2 times.Conclusion: Due to the decrease of the emergency specialized medical care availability because of the pandemic the excess mortality from severe head injuries in 2020 was not less than 3 thousand people or 15% of the total number of cases of death. Hospital repurposing, redistribution of temporary and physical healthcare resources during the pandemic shouldn’t be followed by the decrease of medical care in emergency cases. The relation indicator of the number of admissions in the round-the-clock hospitals of patients with severe injuries or diseases to total number of lethal outcomes due to the same reasons is the indicator showing the availability level of medical care that can’t be delayed.