Evaluating Traumatic Brain Injury Occurrence Patterns Within The Emergency Department and Internal Screening Process Efficacy: A Retrospective Analysis In The Context of COVID-19 (Preprint)

Abstract

In response to the COVID-19 pandemic, the parent study halted recruitment of pediatric traumatic brain injury (TBI) participants into a biobank because in-person enrollment was critical for proper consent and biospecimen procurement. Despite this, the research team maintained existing digital screening efforts to identify potential participants.

The primary objective of this exploratory, retrospective study is to evaluate pediatric TBI emergency department (ED) utilization during the pandemic. The secondary objective aims to appraise the efficacy of the research team’s internal screening processes.

Candidates (i.e. a person who presented to the ED with census data suggesting a potential TBI) were screened from an ED’s Electronic Health Record (EHR) system. A potential participant is defined as an individual who met all inclusion criteria and would be approached by a consenter after further chart review. Preliminary data was cleaned through Google Sheets, which were then coded as ten variables to examine the effects of the pandemic on internal operations and hospital utilization patterns. These variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the programming language R.

The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants were identified in 2020 (222/633; 35.1%) versus 2019 (195/908; 21.4%). A significantly greater proportion of potential participants had a visit reason indicative of a TBI in 2020 (181/222; 81.5%) versus 2019 (103/195; 52.8%). A significantly greater proportion of these injuries occurred inside (39/181; 21.5%) in 2020 versus 2019 (11/103; 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older in 2019 (mean=8.93) versus 2020 (mean=7.31). Screeners spent significantly longer to identify potential participants in March 2020 (55 minutes) versus March 2019 (32 minutes), but spent significantly shorter to do so in July 2020 (22 minutes) versus July 2019 (42 minutes). Screening coverage was significantly less in March 2020 (241.75 hours) versus March 2019 (346.5 hours). Screening coverage was significantly greater in April 2020 (611.5 hours) and July 2020 (513.5 hours) versus April 2019 (470.5 hours) and July 2019 (404.25 hours), respectively.

There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research.