Lin, Victor, Lele, Abhijit V., Fong, Christine T., Jannotta, Gemi E., Livesay, Sarah, Sharma, Monisha, Bonow, Robert H., Town, James A., Chou, Sherry H., Creutzfeldt, Claire J., and Wahlster, Sarah
• The COVID-19 pandemic created strain on healthcare systems, potentially placing patients with SABI at risk for worse outcomes. • We describe the impact of the initial surge on a tertiary care center in the initial epicenter of the pandemic in the U.S. • Preservation of care is possible at a tertiary care center, however PUIs appear to be a population at risk for delays in care. To investigate the pandemic's impact on critically ill patients with neurological emergencies, we compared care metrics and outcomes of patients with severe acute brain injury (SABI) before and during the initial COVID-19 surge at our institution. We included adult patients with SABI during two separate three-month time periods: 'pre-COVID vs COVID'. We further stratified the COVID cohort to characterize outcomes in patients requiring COVID-19 precautions (Patient Under Investigation, 'PUI'). The primary endpoint was in-hospital mortality; secondary endpoints included length of stay (LOS), diagnostic studies performed, time to emergent decompressive craniectomies (DCHC), ventilator management, and end-of-life care. We included 394 patients and found the overall number of admissions for SABI declined by 29 % during COVID (pre-COVID n = 231 vs COVID, n = 163). Our primary outcome of mortality and most secondary outcomes were similar between study periods. There were more frequent extubation attempts (72.1 % vs 76 %) and the mean time to extubation was shorter during COVID (55.5 h vs 38.2 h). The ICU LOS (6.10 days vs 4.69 days) and hospital LOS (15.32 days vs 11.74 days) was shorter during COVID. More PUIs died than non-PUIs (51.7 % vs 11.2 %), but when adjusted for markers of illness severity, this was not significant. We demonstrate the ability to maintain a consistent care delivery for patients with SABI during the pandemic at our institution. PUIs represent a population with higher illness severity at risk for delays in care. Multicenter, longitudinal studies are needed to explore the impact of the pandemic on patients with acute neurological emergencies. [ABSTRACT FROM AUTHOR]