O efeito da pandemia de Covid-19 na epidemiologia do traumatismo cranioencefálico no Brasil

Abstract

Traumatic Brain Injury (TBI) is an injury caused by an external force that affects cranial or brain structures and is one of the leading causes of death in people under 45 years of age. TBI is a global public health issue with significant medical and socioeconomic impact. In Brazil, there are on average about 125,500 hospitalizations and 9,715 annual deaths due to TBI, and the average annual cost of hospital expenses is estimated to be around 156 million reais. However, these estimates may be underestimated due to underreported cases and the lack of emergency units in some regions. The COVID-19 pandemic was declared by the World Health Organization (WHO) on March 11, 2020, forcing governments to adopt restrictive measures and generally affecting the epidemiology of trauma. Studies indicate a reduction in hospital admissions for trauma and changes in injury patterns during the pandemic, as well as impacts on costs and mortality. However, studies on the impact of the pandemic on TBI are still scarce, especially in less developed countries. This study aims to investigate the impact of the COVID-19 pandemic on TBI in adults by analyzing medical record data from two periods: May 2019 (before the pandemic) and May 2020 (during the pandemic), at a tertiary trauma reference hospital in Brazil. The results indicate a slight reduction in the number of TBI cases during the pandemic (458 in 2019 vs. 419 in 2020), a reduction in TBIs related to sports activities (2.2% in 2019 vs. 0.5% in 2020, p-value=0.03), fewer cranial CT scans performed (9.0% in 2019 vs. 4.1% in 2020, p-value=0.004), and an increase in TBIs associated with alcohol or drug use (18.3% in 2019 vs. 31.5% in 2020, p-value<0.001). The mortality rate decreased from 4.4% in 2019 to 2.6% in 2020 (a trend, but no statistical difference), and there were no differences in severity considering the Glasgow Coma Scale. Regarding the epidemiological profile, BTI was more prevalent among men (65.9%), young people (41.3% under 40 years old and 71.6% under 60 years old), and in mixed-race individuals (69.9%). Belo Horizonte was the most frequent city of origin (72.1%). Regarding surgeries performed, there was an increase in intraparenchymal hematoma drainages (6.3% in 2019 vs. 33.3% in 2020) and a decrease in decompressive craniectomies (25% in 2019 vs. 6.7% in 2020) and acute subdural hematoma drainages (37.5% in 2019 vs. 13.3% in 2020). It is concluded that the pandemic altered the BTI profile, reflecting changes in the population's social behavior, such as reduced sports activities and increased alcohol and drug use, also altering the pattern of traumatic injuries and, consequently, the most commonly performed surgeries. Additionally, fewer cranial CT scans were performed. Despite this, there was a reduction in the TBI-related mortality rate during the pandemic. These findings can help in formulating public health policies to address future pandemics.