Implementation of Specific Neurosurgical Protocol for Urgent Elective and Emergency Patients during the COVID-19 Pandemic in Croatia: Institutional Experience

1-4 Bruno Splavski
1-3 Krešimir Rotim
1,2 Mia Jurilj
1,2 Tomislav Sajko

1 Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
2 University of Applied Health Sciences, Zagreb, Croatia
3 J. J. Strossmayer University Faculty of Medicine, Osijek, Croatia
4 J. J. Strossmayer University Faculty of Dental Medicine and Health, Osijek, Croatia


The COVID-19 pandemic was declared on January 30, 2020. The disease has rapidly disseminated throughout Europe, reaching Croatia from late February onward, representing a great burden to the national health care system. Our institution’s capacity for emergency neurosurgery was adjusted to assure adequate degree of protection for both the patients and medical workforce. Separate COVID-19-free pathways were ensured, while regular operative program has been attuned to the existing epidemiological condition.

Aim: To explain the implementation of neurosurgical protocol for urgent elective and emergency traumatic brain injury patients during the COVID-19 pandemic based on our institutional experience.

Methods: The time of pandemic was divided into 3 separate two-month periods. Patients, who suffered a traumatic brain injury and were not tested for corona virus, were considered COVID positive and were included in the analysis investigating the type and severity of injury, period of hospital admission and surgery, methods of surgery, and outcome.

Results: A series consisted of 16 patients who were tested for COVID-19 at hospital admission, and under-went urgent/emergency surgery before the test results became known. Surgery was performed according to the specifically designed operative COVID-19 protocol. Skull fracture and traumatic intracranial hemorrhage were mainly observed. Moderate injury was recorded less frequently, particularly during the lock down, and post lock down summer. The majority of patients recuperated well, having good recovery.

Conclusion: A specific operative protocol, employment of protective measures, and a separate operating theatre are mandatory for a safe and successful management of traumatic brain injury to evade transmission of the infection.

Keywords: COVID-19, traumatic brain injury, operative protocol, protective measures