The influence of COVID-19 on clinical characteristics and prognosis of traumatic brain injury after rehabilitation treatment: An epidemiological comparative study

Abstract

The impact of traumatic brain injury (TBI) on health and epidemiological patterns during the COVID-19 pandemic in China remains poorly understood. This retrospective study aimed to examine the influence of COVID-19 on the epidemiological characteristics, prognosis, and rehabilitation outcomes of TBI patients. Medical records from three hospitals in Wuhan, China, were analyzed between January 2018 and December 2023 to examine TBI patients based on the International Classification of Diseases, 10^th Edition. A total of 306 TBI patients were included in this study, divided into two groups: 186 patients without COVID-19 (Group 1) and 120 patients with COVID-19 (Group 2). The mean age was 39.47 ± 18 years in Group 1 and 40.95 ± 16.6 years in Group 2. Most patients were male. Road traffic accidents represent the leading cause of TBI in both groups, although it is more prevalent in Group 1 (73.7%) than in Group 2 (55.8%). There were no significant differences in injury severity or initial Glasgow Coma Scale scores between the groups. However, Group 2 showed significantly poorer recovery outcomes, as indicated by lower Functional Independence Measure and Barthel Index scores at discharge. In addition, post-surgical infection rates were higher in Group 2 (18.42%) compared to Group 1 (4.25%). This study highlights the need for further evaluation of the impact of COVID-19 on TBI epidemiology and recovery outcomes to guide improvements in health-care practices.

Keywords

Traumatic brain injury / Rehabilitation / COVID-19 / Comparative study

Acknowledgments

None.

Funding

None.

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Ruba Altahla, Jamal Alshorman

Formal analysis: Ruba Altahla

Investigation: Jamal Alshorman

Methodology: Ruba Altahla

Writing - original draft: Ruba Altahla, Jamal Alshorman

Writing - review & editing: Ruba Altahla, Jamal Alshorman

Ethics approval and consent to participate

The ethics committee of the Second Affiliated Hospital, Clinical Medical College, Hubei University of Science and Technology granted approval for this study (approval ID: 20230214) and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Moreover, the Ethics Committee of Affiliated Tongji Medical College Hospital has waived the requirement to obtain informed consent for this study.

Consent for publication

Not applicable.

Availability of data

The supporting data for the findings of this study can be obtained by contacting the corresponding author upon making a reasonable request.

References

[1] Qiu H, Zador Z, Lannon M, Farrokhyar F, Duda T, Sharma S. Identification of clinically relevant patient endotypes in traumatic brain injury using latent class analysis. Sci Rep. 2024; 14(1):1294. doi: 10.1038/s41598-024-51474-0

[2] Wang CC, Schoenberg BS, Li SC, Yang YC, Cheng XM, Bolis CL. Brain injury due to head trauma. Epidemiology in urban areas of the People’s Republic of China. Arch Neurol. 1986; 43(6):570-572. doi: 10.1001/archneur.1986.00520060034013

[3] Zhao YD, Wang W. Neurosurgical trauma in People’s Republic of China. World J Surg. 2001; 25(9):1202-1204. doi: 10.1007/s00268-001-0082-8

[4] BD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5):459-480. doi: 10.1016/S1474-4422(18)30499-X

[5] Giner J, Mesa Galan L, Yus Teruel S, et al. Traumatic brain injury in the new millennium: New population and new management. Neurologia (Engl Ed). 2022; 37(5):383-389. doi: 10.1016/j.nrleng.2019.03.024

[6] European Centre for Disease Prevention and Control. Rapid Risk Assessment: Coronavirus Disease 2019 (COVID-19) in the EU/EEA and the UK-ninth Update. Stockholm: European Centre for Disease Prevention and Control; 2020. p. 1.

[7] Altahla R, Alshorman J, Tao X. The impact of COVID-19 on epidemiological features of spinal cord injury in Wuhan, China: A comparative study in different time periods. Medicina (Kaunas). 2023; 59(10):1699. doi: 10.3390/medicina59101699

[8] Chen DE, Tay EK, Tan PL, et al. The Impact of COVID-19 pandemic on rehabilitation in Singapore. Ann Acad Med Singap. 2020; 49(11):925-927. doi: 10.47102/annals-acadmedsg.2020297

[9] Singh R, Burn J, Sivan M. A letter in response to the SIMFER document on the impact of COVID-19 on Italian rehabilitation services and activities. Eur J Phys Rehabil Med. 2020; 56(3):368-369. doi: 10.23736/S1973-9087.20.06296-6

[10] Prvu Bettger J, Thoumi A, Marquevich V, et al. COVID-19: Maintaining essential rehabilitation services across the care continuum. BMJ Glob Health. 2020; 5(5):e002670. doi: 10.1136/bmjgh-2020-002670

[11] Stein J, Visco CJ, Barbuto S. Rehabilitation medicine response to the COVID-19 pandemic. Am J Phys Med Rehabil. 2020; 99(7):573-579. doi: 10.1097/PHM.0000000000001470

[12] Chaler J, Gil Fraguas L, Gomez Garcia A, et al. Impact of coronavirus disease 2019 outbreak on rehabilitation services and physical rehabilitation medicine and rehabilitation physicians’ activities: Perspectives from the Spanish experience. Eur J Phys Rehabil Med. 2020; 56(3):369-371. doi: 10.23736/S1973-9087.20.06304-2

[13] Altahla R, Alshorman J. Rehabilitation following decompression surgery for epiconus syndrome and cauda equina syndrome due to traumatic injury: A case report. J Prev Complement Med. 2024; 3(2):92-96. doi: 10.22034/jpcm.2024.445418.1170

[14] Servadei F, Cannizzaro D. Effects on traumatic brain injured patients of COVID pandemia: Which responses from neurosurgical departments? Acta Neurochir (Wien). 2021; 163(4):1051-1052. doi: 10.1007/s00701-021-04724-3

[15] Damara FA, Muchamad GR, Anton A, Ramdhani AN, Channel IC, Faried A. Epidemiological pattern of traumatic brain injury in the COVID-19 pandemic: A systematic review and meta-analysis. World Neurosurg. 2022; 161:e698-e709. doi: 10.1016/j.wneu.2022.02.081

[16] Rajalu BM, Indira Devi B, Shukla DP, et al. Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment. BMJ Open. 2022; 12(4):e052639. doi: 10.1136/bmjopen-2021-052639

[17] Manivannan S, Sharouf F, Mayo I, et al. Management of neurotrauma during COVID-19: A single centre experience and lessons for the future. Brain Inj. 2021; 35(8):957-963. doi: 10.1080/02699052.2021.1934731

[18] Madhok DY, Nardone A, Caceres EU, Wong AHK, Zhang L, Rodriguez RM. The impact of the COVID-19 shelter-inplace order on traumatic brain injuries in San Francisco, California. J Emerg Med. 2023; 65(6):e479-e86.

[19] Zhang M, Zhou J, Dirlikov B, Cage T, Lee M, Singh H. Impact on neurosurgical management in a level 1 trauma center post COVID-19 shelter-in-place restrictions. J Clin Neurosci. 2022; 101:131-136. doi: 10.1016/j.jocn.2022.04.033

[20] Lester A, Leach P, Zaben M. The impact of the COVID-19 pandemic on traumatic brain injury management: Lessons learned over the first year. World Neurosurg. 2021; 156:28-32. doi: 10.1016/j.wneu.2021.09.030

[21] Li Y, Gu J, Zhou J, et al. The epidemiology of traumatic brain injury in civilian inpatients of Chinese Military Hospitals, 2001-2007 Brain Inj. 2015; 29(7-8):981-988. doi: 10.3109/02699052.2014.989405

[22] World Health Organization. International Statistical Classification of Diseases and Related Health Problems: Alphabetical Index. Geneva: World Health Organization; 2004.

[23] Yang C, Lang L, He Z, et al. Epidemiological characteristics of older patients with traumatic brain injury in China. J Neurotrauma. 2022; 39(11-12):850-859. doi: 10.1089/neu.2021.0275

[24] World Health Organization. Coronavirus Disease (COVID-2019) Situation Reports. Geneva: World Health Organization; 2020

[25] Jean WC, Ironside NT, Sack KD, Felbaum DR, Syed HR. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: A global neurosurgery study. Acta Neurochir (Wien). 2020;162:1229-1240. doi: 10.1007/s00701-020-04342-5

[26] Ozdemir O, Diren F, Boyalı O, Kahraman M, Kabataş S, Civelek E. The effect of COVID-19 pandemic on the frequency of spinal trauma: An epidemiological study. J Turk Spinal Surg. 2022; 33(1):36-40. doi: 10.4274/jtss.galenos.2022.18209

[27] Chua KSG, Kwan HX, Teo WS, Cao RX, Heng CP, Ratha Krishnan R. Changing epidemiology and functional outcomes of inpatient rehabilitation in Asian traumatic brain injury cases before and during the COVID-19 pandemic: A retrospective cohort study. Life (Basel). 2023; 13(7):1475. doi: 10.3390/life13071475

[28] Pinggera D, Klein B, Thome C, Grassner L. The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: Experiences from a state under lockdown. Eur J Trauma Emerg Surg. 2021;47:653-658. doi: 10.1007/s00068-020-01445-7

[29] Zou JF, Fang HL, Wu CW, et al. The epidemiology of traumatic brain injuries in the fastest-paced city in China: A retrospective study. Front Neurol. 2023;14:1255117. doi: 10.3389/fneur.2023.1255117

[30] Jiang JY, Gao GY, Feng JF, et al. Traumatic brain injury in China. Lancet Neurol. 2019; 18(3):286-295. doi: 10.1016/S1474-4422(18)30469-1

[31] Smith L, Jacob L, Trott M, et al. The association between screen time and mental health during COVID-19: A cross sectional study. Psychiatry Res. 2020;292:113333. doi: 10.1016/j.psychres.2020.113333

[32] Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020; 87:34-39. doi: 10.1016/j.bbi.2020.04.027

[33] Poyry T, Luoto TM, Kataja A, et al. Acute assessment of brain injuries in ground-level falls. J Head Trauma Rehabil. 2013; 28(2):89-97. doi: 10.1097/HTR.0b013e318250eadd

[34] Gopal N, Kumar A, Singh AK, Dubey SA. Risk factor assessment and outcome analysis in elderly (≥60 years) patients of severe head injury. Int Surg J. 2020; 7(8):2548-2552. doi: 10.18203/2349-2902.isj20203233

[35] Richards JS, Bombardier CH, Tate D, et al. Access to the environment and life satisfaction after spinal cord injury. Arch Phys Med Rehabil. 1999; 80(11):1501-1506. doi: 10.1016/s0003-9993(99)90264-2

[36] Howrey BT, Graham JE, Pappadis MR, Granger CV, Ottenbacher KJ. Trajectories of functional change after inpatient rehabilitation for traumatic brain injury. Arch Phys Med Rehabil. 2017; 98(8):1606-1613. doi: 10.1016/j.apmr.2017.03.009

[37] Beninato M, Gill-Body KM, Salles S, Stark PC, Black- Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil. 2006; 87(1):32-39. doi: 10.1016/j.apmr.2005.08.130

[38] von Steinbuechel N, Hahm S, Muehlan H, et al. Impact of sociodemographic, premorbid, and injury-related factors on patient-reported outcome trajectories after Traumatic Brain Injury (TBI). J Clin Med. 2023; 12(6):2246. doi: 10.3390/jcm12062246

[39] Farace E, Alves WM. Do women fare worse: A metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg. 2000; 93(4):539-545. doi: 10.3171/jns.2000.93.4.0539