Cranial Neurotrauma Outcomes at the “Epicenter of the Epicenter” of the United States COVID-19 Pandemic Amidst Ongoing Socio-Demographic Challenges

Introduction: Cerebral neurotrauma(cNT) from traumatic brain injury(TBI) poses significant public health challenges with profound impacts. During the COVID-19 pandemic, Elmhurst, Queens was an initial hotspot deemed the “epicenter of the epicenter” of the crisis and weathered major changes in healthcare resource distribution. This study investigated how different phases of the COVID-19 pandemic affected the incidence, severity, and outcomes of cNT in this geographical area.

Methods: cNT admissions to NYC Health+Hospitals/Elmhurst, a Level 1 trauma center, during the first 26 weeks of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19-6/30/19 and 1/1/20-3/10/20)[Group 1], first COVID-19 wave (3/11/20-6/30/20)[Group 2], and second COVID-19 wave (1/1/21-6/30/21)[Group 3]. Univariate analyses were conducted to examine potential associations between variables with clinically significant variables(p < 0.05) included in multivariable analyses.

Results: Analysis of 443 cNT patients (median age: 56[38,73]; mean admissions/week: 5.6±2.7) demonstrated no significant variance in age (H=0.35; p=0.840), sex (χ²=2.2; p=0.332), or ethnicity (χ²=17.1; p=0.075) across groups. Group 2 had fewer weekly admissions (3.9±2.6) compared to Groups 1 (5.9±2.2; p=0.021) and 3 (6.1±2.9; p=0.009). Uninsured patients decreased from 17% to 4.4%, while publicly insured rose from 19% to 28% (p < 0.001) over the course of the pandemic. A multivariable logistic regression model dichotomized by discharge outcome confirmed that increasing age (OR=0.949; 95%CI: 0.933-0.965; p< 0.001) and injury severity score(ISS) (OR=0.878; 95%CI: 0.830-0.929; p< 0.001) were inversely correlated with “good” discharge odds, while higher GCS score (OR=1.264; 95%CI: 1.174-1.361; p< 0.001) was positively correlated. Of particular interest, non-white ethnicity (OR=0.82; 95%CI: 0.69-0.99; p=0.036) and Medicare/Medicaid insurance (OR=0.826; 95%CI: 0.683-0.998; p=0.048) were both associated with less favorable outcomes. Neither patient sex, nor group assignment, was correlated with outcome(p>0.05).

Conclusion : While the COVID-19 pandemic reshaped TBI admission patterns in Queens, New York, the quality of patient outcomes remained consistent across different phases of the pandemic. Demographic, clinical, and socioeconomic factors significantly influenced outcomes, underscoring the need for systemic changes to address disparities in neurotrauma care.