Management protocol for emergency aneurysm craniotomy clipping in non-major COVID-19 epidemic areas in Beijing, China
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(2020) 6:38
中华医学会神经外科学分会 CHINESE MEDICAL ASSOCIATION
CHINESE NEUROSURGICAL SOCIETY
RESEARCH
Open Access
Management protocol for emergency aneurysm craniotomy clipping in nonmajor COVID-19 epidemic areas in Beijing, China Yu Chen1†, Xiaolin Chen1†, Li Ma1, Xiaofeng Deng1, Zelin Li1, Xun Ye1,2, Hao Wang1, Shuai Kang1, Yan Zhang1, Rong Wang1,2, Dong Zhang1, Yong Cao1, Yuanli Zhao1,2,3,4,5,6*, Shuo Wang1,2,3,4,5,6* and Jizong Zhao1,2,3,4,5,6*
Abstract Background: An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China. Methods: Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS). Results: A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (− 0.1, 95% CI − 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019–March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (− 0.3, 95% CI − 1.4 to 0.9, P = 0.653). (Continued on next page)
* Correspondence: [email protected]; [email protected]; [email protected] † Yu Chen and Xiaolin Chen contributed equally to this work. 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate cre
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