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Neurosurgical Referral Patterns During the Coronavirus Disease 2019 Pandemic: A United Kingdom Experience
Nithish Jayakumar1, Oliver Kennion1, Alvaro Rojas Villabona1
1Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Insights
Neurosurgical referrals in the UK significantly decreased during the COVID-19 pandemic, particularly for spine and traumatic brain injury cases. This decline highlights potential risks to patient neurological health that require proactive management strategies.
Area of Science:
- Neurosurgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic caused widespread disruption to healthcare services globally.
- The United Kingdom experienced a significant impact from the pandemic.
- Previous evidence indicated reduced non-emergency presentations for conditions like stroke and cardiac issues due to public avoidance of care.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on neurosurgical referral patterns.
- To analyze referral data for a high-volume UK neurosurgical department during the pandemic.
Main Methods:
- Electronic referrals from January 1 to May 31, 2020, were analyzed, with January serving as the baseline.
- Demographic data and diagnoses were collected and statistically analyzed using SPSS.
- Chi-squared goodness-of-fit tests were employed to assess differences in referral volumes.
Main Results:
- A total of 2293 referrals were received, with a median patient age of 63 years.
- A statistically significant overall decrease in referral volume was observed during the study period (P < 0.001).
- Referrals for degenerative spine conditions and traumatic brain injuries showed a significant reduction (P < 0.001).
Conclusions:
- The pandemic led to a substantial decline in neurosurgical referrals, especially for degenerative spine and traumatic brain injury cases.
- Reduced vehicular traffic and patient hesitancy to seek medical care likely contributed to these decreases.
- Neurosurgeons must develop strategies to address the risks of delayed treatment and potential adverse neurological outcomes as the pandemic evolves.
Background:
Coronavirus disease 2019 (COVID-19) is a severe respiratory viral illness that has spread rapidly across the world. However, the United Kingdom has been particularly affected. Evidence has suggested that stroke, cardiac, and spinal presentations decreased during the pandemic as the public avoided seeking care. The effect on neurosurgical presentations and referrals during COVID-19 is unclear. Our aim, therefore, was to describe the referral patterns to a high-volume neurosurgical department in the United Kingdom during the COVID-19 pandemic.
Methods:
Electronic referrals were identified from the referrals database from January 1, 2020 to May 31, 2020, inclusive, with January used as the baseline. The demographic data and referral diagnoses were captured on Excel (Microsoft, Redmond, Washington, USA). Statistical analyses were performed using SPSS, version 22 (IBM Corp., Armonk, New York, USA). Differences between referral volumes were evaluated using χ2 goodness-of-fit tests.
Results:
A total of 2293 electronic referrals had been received during the study period. The median age was 63 years. Overall, the referrals had decreased significantly in volume during the study period [χ2(4) = 60.95; P < 0.001]. We have described the patterns in the daily referrals as the pandemic progressed. The reduction in the volume of referrals for degenerative spine cases and traumatic brain injuries was statistically significant (P < 0.001).
Conclusions:
The referrals for degenerative spine and traumatic brain injuries decreased significantly during the pandemic, which can be explained by the lower vehicular traffic and patient avoidance of healthcare services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern, and neurosurgeons worldwide should consider the optimal strategies to mitigate these risks as the pandemic eases.
