{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:42:21Z","timestamp":1792798941653,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institute of Health\/Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["R1 HD107280-01"],"award-info":[{"award-number":["R1 HD107280-01"]}],"id":[{"id":"https:\/\/ror.org\/04byxyr05","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,6]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in US emergency departments (EDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This cross-sectional study analysed 2016\u20132020 Nationwide Emergency Department Sample (NEDS) data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>US EDs contained in the NEDS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants were patients with moderate and severe TBI who visited the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Probability sampling design and survey weights generated nationally representative estimates of ED visits by patient demographics, hospital characteristics and COVID-19 diagnosis and the top four leading TBI causes. To assess COVID-19 impact, we calculated the per cent change of estimated TBI ED visits and disposition outcomes from 2016 to 2019 and 2019 to 2020, and proportion and 95% CI of injury severity groups and admitted\/transfer by hospital type and trauma centre level. A multivariable logistic regression model identified the mortality OR by patient demographics, injury severity, hospital characteristics and COVID-19 positive diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2020, there were 527\u2009123 ED visits nationally for TBI, 4.3% higher than 2016 but 1.0% lower than 2019. Patients with TBI transferring to short-term hospitals and other facilities increased by 16.0% and 18.2%, respectively, from 2016 to 2019 and were 3.7% and 14.1% higher in 2020 than in 2019. An estimated 3317 patients with TBI died (in ED or later in hospital) in 2020, which is 9.8% higher than 2019. Firearm-related TBI proportion was 15.1% higher in 2020 than in 2019. Patients with TBI with injury severity scores 25\u201375 were significantly higher at nontrauma (29.4% vs 31.9 %) and level III trauma centres (34.9% vs 38.2%) in 2020 than in 2019. Patients with TBI treated at rural hospitals had significantly higher odds of mortality (OR=1.95, CI=1.58\u20132.40) than those at urban hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TBI patient mortality was higher at all US hospital types and almost all trauma centre levels in 2020 than in 2019. Patients with TBI treated at rural hospitals had a significantly higher mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090141","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T02:07:12Z","timestamp":1732846032000},"page":"e090141","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of COVID-19 pandemic on traumatic brain injury emergency department visits, interfacility transfer and mortality in the United States, 2016\u20132020: a cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"given":"Sydney","family":"Gilkey","sequence":"first","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Alexander","sequence":"additional","affiliation":[{"name":"Biostatistics Resource at Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biche","family":"Osong","sequence":"additional","affiliation":[{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1691-8559","authenticated-orcid":false,"given":"Eric A","family":"Sribnick","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, Ohio, USA"},{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M","family":"Stanley","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, Ohio, USA"},{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan I","family":"Groner","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, Ohio, USA"},{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Trauma and Burn Program, Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J","family":"Cook","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, The University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Lu","sequence":"additional","affiliation":[{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Division of Biostatistics, The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8112-319X","authenticated-orcid":false,"given":"Henry","family":"Xiang","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, Ohio, USA"},{"name":"Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"},{"name":"Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"2025120520064478000_14.11.e090141.1","article-title":"The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status","volume":"7","author":"Guo","year":"2020","journal-title":"Mil Med Res"},{"key":"2025120520064478000_14.11.e090141.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6936a4"},{"key":"2025120520064478000_14.11.e090141.3","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1016\/j.jaccas.2020.04.010","article-title":"Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic","volume":"2","author":"Moroni","year":"2020","journal-title":"JACC Case Rep"},{"key":"2025120520064478000_14.11.e090141.4","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.584522","article-title":"Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage","volume":"11","author":"Abdulazim","year":"2020","journal-title":"Front Neurol"},{"key":"2025120520064478000_14.11.e090141.5","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/PEC.0000000000002203","article-title":"A Blueprint for Pediatric Emergency Resource Reallocation During the COVID-19 Pandemic: An NYC Hospital Experience","volume":"36","author":"Fraymovich","year":"2020","journal-title":"Pediatr Emerg Care"},{"key":"2025120520064478000_14.11.e090141.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.05.006"},{"key":"2025120520064478000_14.11.e090141.7","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.4103\/joacp.JOACP_272_20","article-title":"Trauma care and COVID-19 pandemic","volume":"36","author":"Sawhney","year":"2020","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025120520064478000_14.11.e090141.8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.wneu.2021.09.030","article-title":"The Impact of the COVID-19 Pandemic on Traumatic Brain Injury Management: Lessons Learned Over the First Year","volume":"156","author":"Lester","year":"2021","journal-title":"World Neurosurg"},{"key":"2025120520064478000_14.11.e090141.9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1080\/02688697.2020.1777263","article-title":"Impact of COVID-19 pandemic on acute spine surgery referrals to UK tertiary spinal unit: any lessons to be learnt?","volume":"35","author":"Ahuja","year":"2021","journal-title":"Br J Neurosurg"},{"key":"2025120520064478000_14.11.e090141.10","doi-asserted-by":"crossref","first-page":"e698","DOI":"10.1016\/j.wneu.2022.02.081","article-title":"Epidemiological Pattern of Traumatic Brain Injury in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis","volume":"161","author":"Damara","year":"2022","journal-title":"World Neurosurg"},{"key":"2025120520064478000_14.11.e090141.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30371-X"},{"key":"2025120520064478000_14.11.e090141.12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2020.08.083","article-title":"The Effects of Lockdown During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Neurotrauma-Related Hospital Admissions","volume":"146","author":"Figueroa","year":"2021","journal-title":"World Neurosurg"},{"key":"2025120520064478000_14.11.e090141.13","doi-asserted-by":"crossref","DOI":"10.25259\/SNI_675_2020","article-title":"\u201cLocked up inside home\u201d - Head injury patterns during coronavirus disease of 2019 pandemic","volume":"11","author":"Goyal","year":"2020","journal-title":"Surg Neurol Int"},{"key":"2025120520064478000_14.11.e090141.14","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1016\/j.wneu.2020.07.155","article-title":"\u201cStaying Home\u201d\u2014Early Changes in Patterns of Neurotrauma in New York City During the COVID-19 Pandemic","volume":"143","author":"Lara-Reyna","year":"2020","journal-title":"World Neurosurg"},{"key":"2025120520064478000_14.11.e090141.15","unstructured":"Healthcare Cost and Utilization Project (HCUP) . HCUP Nationwide Emergency Department Sample (NEDS) Rockville, MD: Agency for Healthcare Research and Quality. 2016, 2017, 2018, 2019, 2020. Available: www.hcup-us.ahrq.gov\/nedsoverview.jsp"},{"key":"2025120520064478000_14.11.e090141.16","unstructured":"Hedegaard H , Johnson RL , Warner M , et al . Proposed framework for presenting injury data using the international classification of diseases, tenth revision, clinical modification diagnosis codes. Hyattsville, MD: National Center for Health Statistics, 2016."},{"key":"2025120520064478000_14.11.e090141.17","unstructured":"SAS Institute Inc . SAS\/STAT 13.1 User\u2019s Guide Cary, NC: SAS Institute Inc. 2013."},{"key":"2025120520064478000_14.11.e090141.18","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1001\/jama.2023.5348","article-title":"Risk of Death in Patients Hospitalized for COVID-19 vs Seasonal Influenza in Fall-Winter 2022-2023","volume":"329","author":"Xie","year":"2023","journal-title":"JAMA"},{"key":"2025120520064478000_14.11.e090141.19","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.40.11\/12.02"},{"key":"2025120520064478000_14.11.e090141.20","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1080\/02699052.2021.1934731","article-title":"Management of neurotrauma during COVID-19: a single centre experience and lessons for the future","volume":"35","author":"Manivannan","year":"2021","journal-title":"Brain Inj"},{"key":"2025120520064478000_14.11.e090141.21","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1016\/j.wneu.2021.04.004","article-title":"Impact of Coronavirus Disease 2019 Shutdown on Neurotrauma Volume in Pennsylvania","volume":"151","author":"Algattas","year":"2021","journal-title":"World Neurosurg"},{"key":"2025120520064478000_14.11.e090141.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052639","article-title":"Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment","volume":"12","author":"Rajalu","year":"2022","journal-title":"BMJ Open"},{"key":"2025120520064478000_14.11.e090141.23","unstructured":"American Heart Association News . Is it safe to go to the hospital during covid-19 pandemic? doctors say yes. american heart association news stories. 2020. Available: https:\/\/www.heart.org\/en\/news\/2020\/05\/04\/is-it-safe-to-go-to-the-hospital-during-covid-19-pandemic-doctors-say-yes"},{"key":"2025120520064478000_14.11.e090141.24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.tcm.2020.12.003","article-title":"Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021","volume":"31","author":"Jain","year":"2021","journal-title":"Trends Cardiovasc Med"},{"key":"2025120520064478000_14.11.e090141.25","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2020.305864"},{"key":"2025120520064478000_14.11.e090141.26","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s10900-023-01216-6","article-title":"Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022","volume":"48","author":"Giannouchos","year":"2023","journal-title":"J Community Health"},{"key":"2025120520064478000_14.11.e090141.27","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1055\/s-0040-1712553","article-title":"Neurotrauma in the Time of SARS-COV 2: A Checklist for Its Safe Management","volume":"11","author":"Salazar","year":"2020","journal-title":"J Neurosci Rural Pract"},{"key":"2025120520064478000_14.11.e090141.28","doi-asserted-by":"publisher","DOI":"10.3171\/2017.10.jns17352"},{"key":"2025120520064478000_14.11.e090141.29","unstructured":"Faul M , Xu L , Wald MM , et al . Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002\u20132006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010."},{"key":"2025120520064478000_14.11.e090141.30","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1097\/SLA.0000000000003996","article-title":"Trauma Does not Quarantine: Violence During the COVID-19 Pandemic","volume":"272","author":"Hatchimonji","year":"2020","journal-title":"Ann Surg"},{"key":"2025120520064478000_14.11.e090141.31","doi-asserted-by":"crossref","DOI":"10.1016\/j.ypmed.2020.106281","article-title":"Stay-at-home orders and firearms in the United States during the COVID-19 pandemic","volume":"141","author":"Hoops","year":"2020","journal-title":"Prev Med"},{"key":"2025120520064478000_14.11.e090141.32","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jamcollsurg.2020.10.009","article-title":"COVID-19 and Firearm Injury: A Uniquely American Problem","volume":"232","author":"Sarani","year":"2021","journal-title":"J Am Coll Surg"},{"key":"2025120520064478000_14.11.e090141.33","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15296"},{"key":"2025120520064478000_14.11.e090141.34","doi-asserted-by":"publisher","DOI":"10.1136\/ip-2023-044971"},{"key":"2025120520064478000_14.11.e090141.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207766","article-title":"Identifying temporal patterns in trauma admissions: Informing resource allocation","volume":"13","author":"Stonko","year":"2018","journal-title":"PLoS One"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-090141","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T04:06:56Z","timestamp":1764994016000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-090141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,28]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-090141"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090141","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}