(1779) COVID-19 Pandemic Impact on Mortality Trends of TBI Hospitalizations: A Population-Level Analysis

Introduction: The COVID-19 pandemic disrupted health care systems and strained hospital resources. The impact of the pandemic on temporal trends in short-term mortality among TBI hospitalizations was not clear.

Methods: We used publicly available and statewide data to study emergency and trauma admissions aged ≥ 18 years admitted to ICUs at acute care hospitals in Texas during 2016 - 2022. The study population was identified using Clinical Classification Software Refined (CCSR) category INJ008: Traumatic brain injury (TBI); concussion, initial encounter. Short term mortality was defined as in-hospital mortality or discharge to hospice. Hospitalizations transferred to another acute care hospital were excluded. Interrupted time series analysis (ITSA) based on risk adjusted multilevel logistic regression was used as the primary analysis approach with results reported as average marginal effect and 95% confidence interval (AME, 95% CI). The response variables were initial time trend, pandemic level change, change in time trend, and final time trend. Sensitivity analyses was completed for hospitalizations without a diagnosis of COVID-19.

Results: A total of 71,937 hospitalizations were included in the study of which 39,494 (54.9%) occurred after the beginning of the pandemic. 1,048 (2.6%) of the pandemic hospitalizations had a diagnosis of COVID-19. Unadjusted short-term mortality was lower in the pre-pandemic period compared to the post-pandemic period (14.7% vs 16.3%). On adjusted analysis, the post-pandemic period remained associated with higher mortality rates. There was no pre-pandemic short-term mortality time trend was negative (AME 0.05% / quarter, 95% CI [-0.16% to 0.26%], p = 0.6564). The change in time trend was positive (AME 0.50% / quarter, 95% CI [0.38% to 0.62%], p < 0.0001) and the change in level was positive (AME 2.12%, 95% CI [1.19% to 3.05%], p < 0.0001). The final time trend was significant and positive (AME 0.54% / quarter, 95% CI [0.33% to 0.76%], p < 0.0001). The difference and 95% CI for the between ITSA and counterfactual predicted probabilities of mortality was 4.38% (4.34% to 4.43%).

Conclusions: The pandemic is associated with higher short-term mortality and the pre-pandemic stable time trend in short-term mortality has been changed to a post pandemic increasing time trend.