Impact of societal restrictions and lockdown on trauma admissions during the COVID‐19 pandemic: a single‐centre cross‐sectional observational study

Abstract

Background: Societal restrictions and lockdown during the coronavirus (COVID-19) pandemic have had a significant impact on the volume and nature of trauma admissions. We assessed the impact of COVID-19 related societal restrictions and lockdown on trauma admissions to single level 1 trauma centre in Westmead, Australia. We hypothesized that the number of trauma admissions would decrease and number of admissions due to selfharm and assault (specifically domestic violence) would increase. Methods: Data was collected from the prospectively maintained Westmead Hospital Trauma Registry. The primary outcome compared was the average number of trauma admissions during March and April during years 2016 to 2020. Analysis of variance was used to analyse means. Pairwise differences among group means were evaluated with Tukey's honestly significant difference test. Secondary outcomes compared were in-hospital interventions and patient outcomes. Results: There was a 23-34% decrease (P = 0.018) in the mean monthly average trauma admissions during March/April 2020 compared with previous years 2016-2019. In addition, there was a 40-52% decrease (P = 0.025) and 13-29% decrease (P = 0.020) in admissions due to road traffic collisions and falls respectively. Conclusion: There was a significant decrease in the overall number of trauma-related admissions during the COVID-19-related period of societal restrictions and lockdown. This was due to a decrease in minor traumas, falls and road traffic collisions. There was no difference in the number of admissions secondary to major traumas, self-harm or assault.

The global burden of trauma during the COVID-19 pandemic: A scoping review

“… 57 A significant increase was also shown in Rhodes et al‘s US centre (0.77% v 0.1%, p = 0.025), Jacob et al in Australia (35.1% v 34.9%, p = 0.02) 51 and Dhillon's centre in India (20% vs 5.49%). 53 Smaller increases were reported in the UK, 20 Australia 50 , 61 and the US. 32 Reductions in the proportion of falls were reported by Staunton et al in Ireland (36% vs 45%), 33 Nabian et al in Iran (49.3% v 58.9%, p = 0.008) 37 , New Zealand 12 and centres in the UK 45 , 49 and US.…”

“…2 b. A reduction in trauma occurring secondary to RTCs was reported in the UK, 10 , 20 , 45 , 49 US 17, 26, 40, 51, 52, 55 , New Zealand, 12 Australia, 31 , 50 India, 53 , 57 Iran, 37 Hong Kong 58 and Europe. 13 , 19 , 22 , 36 , 59 , 60 These reductions reached statistical significance in Jacob et al‘s Australian centre (34% v 46%, p = 0.025), and Sherman et al‘s US centre (42% v 49%, p = 0.03).…”

“… 48 Of the 7 studies reporting the injury severity score (ISS) of patients presenting during the pandemic, 5 reported a similar or slightly reduced presenting ISS during the pandemic, when compared with pre-pandemic years. 34 , 40 , 49 , 50 , 51 However, 2 centres in the United States (US) reported an increase in presenting ISS of 13.7–33%. 29 , 52 …”

“…During lockdown a reported increase in injuries from deliberate self-harm (DSH) was found in Paris (2.9% v 2.0%), 19 the UK, 38 , 49 Australia 47 , 50 and the US. 40 , 52 A large reduction was reported in diamond et al‘s US centre 29 (0 v 8%), with a milder reduction in Murphy et al‘s UK centre 54 (0.2% v 1%, p = 1.0).…”

“…Reductions of between 18.9 and 44.2% were reported in centres in the UK, 54 , 66 US 11 , Europe 36 , 39 , 60 , 67 and Hong Kong. 58 However, increases in the proportion of patients managed operatively were noted in the UK, 10 Paris, 19 the US, 29 , 32 Australia 50 and India. 53 …”