Decreased adult trauma admission volumes and changing injury patterns during the COVID-19 pandemic at 85 trauma centers in a multistate healthcare system

Berg, Gina M.; Wyse, Ransom J; Morse, Jennifer; Chipko, John; Garland, Jeneva M; Slivinski, Andrea; Lieser, Mark; Biswas, Saptarshi; Carrick, Matthew M.; Rhodes, Heather; Acuna, David; Watts, Dorraine D.; Wilson, Nina Y; Shen, Yan; Deas, Shenequa; Fakhry, Samir M.

doi:10.1136/tsaco-2020-000642

Cited by 41 publications

(55 citation statements)

References 15 publications

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“…In our study, trauma surgery covered almost 30% of the whole surgical volumes. We observed a significant decrease in trauma surgery, in line with several reports from other countries and from the adult counterpart [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. We agree with some authors that this decline in emergency referrals was more related to the combination of seasonal trends of pediatric trauma and concomitant restriction of sportive and outdoor recreational activities during the lockdown periods, rather than the effect of contraction or reallocation of healthcare resources [ 10 , 11 , 12 ].…”

Section: Discussionsupporting

confidence: 92%

“…[ 18 , 19 , 20 , 21 ]. Another and more worrying explanation could be that, while the overall volumes of trauma patients decreased, the injury pattern changed, as reported in recent studies concerning adult trauma [ 13 , 14 ], thus requiring hospitalization more frequently. Lockdown- and quarantine-related measures, such as school closings and social isolation, could have increased domestic violence, child abuse or neglect, and self-harm.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, our study was not designed to distinguish the type, causes and severity of trauma requiring surgery; therefore, we cannot provide further evidence in favor of or against this hypothesis. Nonetheless, we emphasize that outreach and injury prevention messaging may be useful in response to the potential adverse effects of lockdown or quarantine, especially in children [ 13 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

et al. 2021

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Background: We aimed to investigate the variation of medical and surgical activities in pediatric orthopedics in Italy, during the year of the COVID-19 pandemic, in comparison with data from the previous two years. The differences among the first wave, phase 2 and second wave were also analyzed. Methods: We conducted a retrospective multicenter study regarding the clinical and surgical activities in pediatric orthopedics during the pandemic and pre-pandemic period. The hospital databases of seven tertiary referral centers for pediatric orthopedics and traumatology were queried for events regarding pediatric orthopedic patients from 1 March 2018 to 28 February 2021. Surgical procedures were classified according to the “SITOP Priority Panel”. An additional classification in “high-priority” and “low-priority” surgery was also applied. Results: Overall, in 2020, we observed a significant drop in surgical volumes compared to the previous two years. The decrease was different across the different classes of priority, with “high-priority” surgery being less influenced. The decrease in emergency department visits was almost three-fold greater than the decrease in trauma surgery. During the second wave, a lower decline in surgical interventions and a noticeable resumption of “low-priority” surgery and outpatient visits were observed. Conclusion: Our study represents the first nationwide survey quantifying the impact of the COVID-19 pandemic on pediatric orthopedics and traumatology during the first and second wave.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

et al. 2021

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“…One of the leading reasons for emergency admissions is traumatic injuries. In the literature, many studies reported that there was also a decrease in admissions to the emergency departments attributable to trauma during the COVID-19 pandemic [6][7][8][9]. The vast majority of these studies were associated with orthopedic injuries and did not contain abdominal trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Injury Mechanism, Volume, and Severity of General Surgical Trauma Patients During COVID-19 Lockdown

Çiftçi¹

2021

Cureus

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BackgroundAfter the declaration of the COVID-19 pandemic, countries have taken many restriction measures to reduce the spread of the virus and ensure the health system's proper functioning. Our knowledge about the general surgery trauma patients being affected by the restrictions is very limited. ObjectiveTo examine the association of the lockdown measurements during the COVID-19 pandemic with general surgical trauma patients' volume and severity at a university teaching hospital. MethodsAll patients admitted to the emergency department because of trauma and evaluated by the general surgery team were examined in two groups. The COVID-19 restrictions period ( 17March 2020 -31 May 2020) and the corresponding time last year (17 March 2019 -31 May 2019). Demographic properties, injury mechanisms, emergency trauma scores (ETS), hospital length of stays (HLOS), intensive care unit (ICU) admission rates, surgical interventions, and mortality were compared. ResultsThe number of patients in the restrictions period is 30% lower than the before COVID-19 cohort. ETS was significantly higher in the restrictions period compared to the previous year, whereas no significant difference was detected in terms of injury mechanisms between the groups (p=0.001 vs p=0.493, respectively). HLOS was found to be higher in the restrictions period (p=0.038). ConclusionsAlthough there was a decrease in the number of general surgical trauma admissions, a significant increase in the severity of trauma was observed during COVID-19 restrictions. We hope these findings will help authorities to guide resource allocation in future pandemic waves.

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“…Traumatic injury patterns are linked to population behaviours, and COVID-19 Pandemic has changed the population behaviours significantly [8]. Whilst the patient demographics remain similar, there has been a reduction in the volume of traumatic adult and paediatric injuries [8][9][10]. The severity of these injuries has gone up on average, and a higher proportion of patients requiring surgery has been described [8,10].…”

Section: Introductionmentioning

confidence: 99%

Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK

Usman¹,

Tarar²,

Toe³

et al. 2021

Cureus

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IntroductionThe United Kingdom was one of the hardest-hit countries during the COVID-19 Pandemic. The UK government announced three national lockdowns to control the spread of the coronavirus and prevent the NHS from getting overburdened with COVID-19 related attendances. Two of the most significant peaks in terms of COVID-19 related hospitalizations and COVID-19 related deaths were in Summer 2020 (corresponding to lockdown 1, which was in effect from 26th March to 26th May 2020) and early 2021 (corresponding to lockdown 3, which was in effect 6th January to 8th March 2021).During this time, a significant proportion of NHS resources was being diverted towards the treatment of COVID-19 patients. Measures were being taken to prevent unnecessary hospitalizations and reduce patient contact. These included but were not limited to measures to reduce attendances to Emergency departments, introducing telemedicine clinics, and pausing elective services.Our hospital is a Major Trauma Centre providing Tertiary Pelvic trauma service to the Greater Manchester area and the North West of England. We conducted this retrospective comparative study to compare the trends in presentation and Management of Pelvic trauma and identify trends in how these changed throughout the pandemic. We want to share these insights with our readers. MethodologyWe conducted a retrospective comparative study by comparing two cohorts of patients, patients presenting to the Pelvic Trauma service during Lockdown 1 and Lockdown 3 in the UK, named Group A and Group B, respectively. Data on patient demographics, injuries, and their management was identified from the Electronic Patient Record System. The data analysis was carried out with the aid of Stata/IC version 16.1. using descriptive Statistics. ResultsGroup A contained 19 patients, with a mean age of 66.9 years. Group B contained 23 patients with a mean age of 67.4 years. There was no statistically significant difference in these patients' population demographics, injury patterns, and management (operative vs conservative). However, there was an absolute reduction in the complication rate from Group A to Group B of 17.2% (26.3% vs 9.1%). The higher complication rate during Lockdown 1 can be explained by conservatively managing Pelvic and Acetabular Fractures that would have been eligible for fixation, had COVID-19 not been a factor. ConclusionsWithin the limitations of our study, it appears that operatively managing a carefully selected cohort of acute Pelvic Trauma patients with proper precautions was safe and effective. It is unclear whether there was an added benefit to having a higher threshold to operate and adopting the watch-and-wait policy in Lockdown 1. We recommend continuing to follow the current evidence and fix these fractures early.

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Decreased adult trauma admission volumes and changing injury patterns during the COVID-19 pandemic at 85 trauma centers in a multistate healthcare system

Cited by 41 publications

References 15 publications

Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

Injury Mechanism, Volume, and Severity of General Surgical Trauma Patients During COVID-19 Lockdown

Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK

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