Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Abstract

Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

“…Patients admitted during the Covid-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality Azbel et al, 2021 [ 44 ] BMC Emerg Med Retrospective cohort Finland The societal restrictions imposed by the Finnish government to curb the spread of Covid-19 had a significant effect on the number of EMS calls related to trauma in the capital area. The number of injured patients intoxicated by alcohol decreased significantly and the decrease was temporally related to the lockdown which included the closure of bars and nightclubs Esteban et al 2020 [ 45 ] Bone Join Open Retrospective Spain A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones Giudici et al, 2021 [ 46 ] World J Emerg Med Retrospective cohort Italy The emergency lockdown during the Covid-19 pandemic in Lombardia led to a reduction of major trauma, especially road-related injuries. The number of patients with intentional injuries admitted to the active level 1 trauma centers was greatly increased during the lockdown and this result would merit further analysis to assess the role of pre-existing factors and their interaction with the imposed restrictions.…”

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

“…In the setting of trauma, although traumatic insult is considered as the first driver of inflammatory responses, other hyperinflammatory states, such as COVID-19, has also the capacity to augment the inflammation (16,17). Recent evidence reported elevated inflammatory response in COVID-19 patients sustaining orthopaedic trauma injuries due to their baseline hyperinflammatory states (16).…”

Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017 – 2021

“…Hospitalizations for injuries clustered in this category as well, with most experiencing a decline in incidence until Jan 2021. These findings are supported by a few studies detailing trauma center admissions, with large declines among injuries due to road traffic conditions which constitute a large portion of trauma admissions [36,37]. Conversely, increases in certain types of severe injuries (i.e.…”