Increased Civilian Penetrating Traumatic Brain Injury Following COVID Stay-At-Home Order: A Retrospective Cohort Study Público
Dawoud, Reem (Spring 2022)
Abstract
Introduction: With the COVID-19 pandemic emerging in 2020, public health measures were instituted to reduce viral transmission, including stay-at-home orders (SAHO). During this time, a record number of firearms were purchased. Nationally, increased rates of violent crime and gunshot wounds (GSW) were reported following the lifting of SAHOs. Metropolitan Atlanta is one of the epicenters of gun violence in the United States, including GSW and civilian penetrating traumatic brain injuries (pTBI). Georgia’s statewide SAHO ended on April 30th. This study looks at trends in pTBI during this time.
Methods: Retrospective study from Grady Memorial Hospital, a large level 1 trauma center in downtown Atlanta, GA. All patients admitted for GSW with pTBI between January 1st 2014 to December 31st 2020 were included. Data analysis was using multivariate logistic regression, non-parametric Wilcox tests, and Fischer’s analysis were used to compare variables.
Results: 407 B-TBI cases presented for evaluation, 357 (85.6%) survived initial resuscitation, and 207 (49.6%) were deemed survivable/amenable for neurosurgical intervention if needed. Cases not offered surgical intervention were based on exam (GCS of 3.6 ± 1.1 vs. 11.4 ± 3.8, p < 0.001) and radiographic findings consistent with global injury including bilateral trajectory, lobes traversed (2.6 vs. 1.1), and herniation (all p < 0.001). 107 (25.6%) patients required neurosurgical intervention with 50 ventriculostomy catheters placed and 91 craniectomy/craniotomy performed. 2020 was the only year where a significant increase in pTBI was observed from May - December (post-SAHO) compared to January - April (Pre- and SAHO) (p = 0.0162). A multivariate logistic regression found that post-SAHO period predicted risk of pTBI (OR=1.73, 95% CI 1.31, 2.26). No difference in pre- and post-lockdown rate of intervention (22.3 vs. 23.9%), mortality (56.8 vs. 46.2%), or outcome (Glasgow Outcome Score 2.5 vs. 2.9, p = 0.18) was observed.
Conclusion: Penetrating TBI represents the most extreme of brain injury and following the completion of the COVID lockdown, a substantial increase was observed. Studies are ongoing to establish predictive factors in B-TBI given this newly established, large dataset from our institution.
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