Spinal neurotrauma outcomes at the “epicenter of the epicenter” of the United States COVID-19 pandemic

Introduction: Spinal neurotrauma (sNT), including spinal cord injury (SCI), poses a significant public health challenge with a variety of downstream sequelae. During the COVID-19 pandemic, Elmhurst, Queens in New York City (NYC) was an initial hotspot dubbed the “epicenter of the epicenter” of the crisis, necessitating large-scale adjustments in healthcare resource allocation. This study aimed to analyze the impact of the COVID-19 pandemic on sNT incidence, severity, and outcomes in this geographical area in light of these stressors. Methods: sNT admissions to NYC Health + Hospitals/Elmhurst, a Level 1 trauma center, during the first 26 weeks of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: Group 1, the pre-pandemic baseline (1/1/19–6/30/19 and 1/1/20–2/29/20); Group 2, the first COVID-19 wave in NYC (3/1/20–6/30/20); and Group 3, which included the beginning of the second COVID-19 wave in NYC (1/1/21–6/30/21). Univariate analyses were conducted to examine potential associations between variables with clinically significant variables (p < 0.05) included in binary logistic regression analysis. Results: Analysis of 232 sNT patients (median age 62 [40, 80] years; mean admissions/week 2.9 ± 1.8) demonstrated no statistically significant differences in age (H = 0.46; p = 0.25), sex (χ² = 2.22; p = 0.06), or ethnicity (χ² = 17.10; p = 0.16) across groups. Average weekly admission rates for Groups 1–3 were 2.9 ± 1.6, 2.4 ± 1.8, and 3.3 ± 1.9, respectively (p = 0.24). Uninsured patients decreased from 5.7 to 0%, while Medicaid coverage increased from 25.5 to 35.9% (p = 0.003) during the pandemic. Binary logistic regression dichotomized by discharge outcome demonstrated that each additional year of age decreased the odds of a good outcome by approximately 6% (OR = 0.94; 95% CI 0.92, 0.96; p < 0.001). Admission injury severity score (ISS) (OR = 0.91; 95% CI 0.864, 0.962; p < 0.001) and GCS score (OR = 1.20; 95% CI 1.07, 1.34; p < 0.001) were both significantly associated with discharge outcome. While it did not reach statistical significance, there was a trend towards poorer outcomes for those with public health insurance (Medicaid/Medicare) coverage (OR = 0.77; 95% CI 0.59, 1.02; p = 0.07). However, group designation, patient sex, COVID-19 status, and need for neurosurgical intervention were not associated with outcome (p > 0.05). Conclusion: Despite the immense strain on healthcare resources in Elmhurst, Queens during the COVID-19 pandemic, neurosurgical intervention and outcomes for sNT patients did not appear to be significantly affected. While discharge outcomes were primarily influenced by injury severity, there was a statistical trend towards poorer outcomes in those with public health insurance.