Hi, my name is Catherine Kelly and I'm a fourth year medical student at Vanderbilt University School of Medicine. Today I'm excited to talk to you about our study titled Pediatric Neurosurgical Care During the COVID-19 Pandemic, a Single Institutional Review. This study was conducted at Vanderbilt University in conjunction with the Department of Pediatric Neurosurgery. Coronavirus has been considered a global pandemic since March of 2020 with an executive order recommending cancellation of all elective procedures. In our state of Tennessee, as of November 2020, we have experienced approximately 258,000 confirmed cases. Following this, concerns have arisen regarding the dichotomization of elective and non-elective procedures and the potential risk to patients of delaying their neurosurgical care. Study of the delay of the pediatric neurosurgical care due to COVID-19 had yet to be studied as the summer of 2020 necessitating our work. On the left graph, you can see data from Johns Hopkins University of the total number of confirmed coronavirus cases in the United States during the spring of this time. And the photo on the right, you can see a heat map of the state of Tennessee depicting where local outbreaks were. Vanderbilt University is located in the center of the state and is considered a safety net for both the state of Tennessee and other surrounding areas in terms of pediatric neurosurgical care. This was a retrospective study of children aged 0 to 18 years old who underwent a neurosurgical inpatient consultation, outpatient appointment, or neurosurgical operation at our institution during the time period between March 23rd, 2019 and April 23rd, 2020. Patients were divided into two groups as either pre- or post-pandemic groups delineated by the March 23rd, 2020 Tennessee Gubernacular Executive Order to cease elective procedures. Using these two groups, we then analyzed them for changes in pediatric care and volumes between the two time periods. This chart depicts the different results in terms of patient cohort demographics. We found that between COVID-19 before and after COVID-19 outbreak, there was no difference in the actual demographics of our patient population, except in the distance traveled to seek pediatric neurosurgical care at our institution increased. Additionally, we found an overall reduction in pediatric neurosurgical cases by 29%, particularly in regards to trauma, cardiotomies, and functional procedures. Pediatric inpatient consultations also decreased significantly, as well as inpatient appointments. However, there was a significant increase in telehealth outpatient appointments, which previously did not exist at our institution, and increased to 10 per week. So what does this all mean? Overall, this study demonstrates that pediatric neurosurgical operations, inpatient consultations, and outpatient clinic appointments significantly decreased during the COVID-19 pandemic, and that functional and traumatic procedures experienced the biggest impact. There's unclear reasoning for the increase in median travel distance for neurosurgical care at our institution. However, it might represent changes in patient behavior during pandemic times. We saw from the study that telehealth poses a viable option for low-risk, non-urgent appointments during pandemic times. In regards to the decrease in trauma craniotomies, Tennessee had a 29% reduction in motor vehicle accidents during the COVID-19 pandemic, which was mirrored in multiple other states nationwide, and could represent this change. In conclusion, our study demonstrates that better strategies are needed for neurosurgical care during pandemic times, and that a conversion to virtual clinics might represent rapid practice adaptation. Long-term outcomes and patient satisfaction will need to be studied in the upcoming years. And one limitation of our study is that this is only one institution, and there has been a limitation in the number of months of data available at this time, and so future directions would be valuable to examine more data, as well as additional institutions.

pediatric neurosurgical care

COVID-19 pandemic

decrease in operations

telehealth outpatient appointments

virtual clinics