Identificação de fatores relacionados com desfecho negativo no TCE grave antes e durante a pandemia do COVID-19 no Brasil

Abstract

Traumatic brain injury (TBI) is a highly heterogeneous condition and can result in a spectrum of outcomes ranging from cases without sequelae to cases with severe sequelae or death. It is one of the most common causes of mortality and morbidity worldwide and represents a significant global social and economic problem. For this reason, it must be continuously studied. The prognostic definition of TBI patients can influence the clinical intervention as well as align expectations between the medical team and the family. Individualized care depends on understanding the circumstances in which the trauma occurred, as well as demographic, social, and cultural characteristics. The COVID-19 pandemic impacted societal behavior through social isolation measures and the closure of commerce and services in various countries, including Brazil. As these were unprecedented measures, there is significant interest in understanding the impact of lockdowns on diseases and healthcare services. This understanding is crucial for optimizing potential unexpected complications, anticipating consequences related to access to healthcare services, and ensuring proper allocation of resources to treat conditions unrelated to COVID-19. The present study aimed to record the incidence of moderate and severe TBI, assess functional and mortality outcomes in the adult population before and during the pandemic period, and identify variables related to these outcomes at a trauma center in Brazil. A cross-sectional, retrospective, and observational study was conducted using admission and discharge data from approximately 100 patients with severe and moderate TBI. Information considered included age, Glasgow Coma Scale (GCS) upon admission, sex, whether they underwent surgical intervention, alcohol use at the time of trauma, prior use of antiplatelet or anticoagulant agents, mortality rates, and functional outcomes using the Glasgow Outcome Scale (GOS). There was no statistical difference in the incidence of moderate and severe TBI or in mortality rates during the assessed periods. There was a higher number of admissions related to alcohol and drug use during the pandemic, and a correlation was demonstrated between the use of these substances and worse outcomes. Additionally, in the evaluation of both periods, a positive correlation was observed between older age, lower GCS, presence of pre-existing comorbidities, use of antiplatelet agents, reported changes in cranial tomography, and the use of alcohol and drugs with worse functional outcomes and death, with a p-value < 0.05.The study reinforces the identification of factors previously known to be related to negative outcomes in moderate and severe TBI and highlights the increased presence of some of these factors in the context of the pandemic. These findings may contribute to optimizing public health strategies aimed at the prevention and treatment of moderate and severe TBI in pandemic and social isolation crisis situations.