Reflections from London’s Level-1 Major Trauma Centres during the COVID crisis

Tahmassebi, Ramon; Bates, Peter; Trompeter, Alex; Bhattacharya, Rajarshi; El-Daly, Ibraheim; Jeyaseelan, Luckshmana; Pearse, Michael

doi:10.1007/s00590-020-02724-0

Cited by 14 publications

(20 citation statements)

References 20 publications

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“…Nunez et al report that ED visits for trauma, workplace accidents and road tra c accidents declined signi cantly compared to the same period in 2019 during the Coronavirus crisis at a tertiary hospital in Spain [15]. In many hospitals orthopedic trauma capacities were adapted (mainly reduced and/or re-organized) due to increased numbers of COVID-19 patients [16].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

Bergrath

Strapatsas

Tuemen

et al. 2020

Preprint

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Background: The outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) led to severe disruption in social life and economics. The present study should analyze the impact of the local COVID-19 epidemic on emergency resources for all hospitals in a major urban center (Moenchengladbach, Germany). Methods: An observational multicenter study was performed involving all four acute care hospitals. Systemic parameters department (ED) parameters from week 4 to 24 in 2020 were compared to the corresponding period in 2019 for each hospital and in a summative data analysis using a logistic regression model. Outcomes: ED visits, ED to hospital admission, ED to Intensive Care Unit (ICU) admission, medical specialties of admitted patients, work related accidents. Results: In week 9/2020 the first SARS-CoV-2 positive patients were detected in our region. All hospitals decided to minimize elective admissions to ensure operational capability for COVID-19 patients. The summative number of ED visits dropped from 34,659 to 28,008. Numbers decreased from week 8 on between 38% and 48% per week per hospital at the maximum and began to rise again from week 16 on. The pooled data analysis showed statistically significant decreases in outpatient ED visits (20,152 vs. 16,477, p=<0.001), hospital admissions of ED patients (14,507 vs. 11,531, p=<0.001), and work-related accidents (2,290 vs. 1,468, p=<0.001). The decrease in admissions from ED to ICU did not reach statistical significance (2,093 vs. 1,566, p=0.255). The decline in ED cases was mainly caused by a decrease in non-trauma and non-surgical patients. Conclusion: The regional COVID-19 outbreak led to significantly reduced ED contacts after the first COVID-19 cases appeared. Even the admissions to the hospitals and the number of ED to ICU-admissions decreased, which is potentially dangerous, because the ratio of emergency outpatients vs. inpatients remained stable. Therefore, one can assume that patients with severe medical problems did not seek ED care in many cases. The decline of patients was earlier than in other German hospitals and in contrast to the findings in the U.S. and Italy where ED visits and hospital admissions in medical disciplines increased.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

Bergrath

Strapatsas

Tuemen

et al. 2020

Preprint

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“…The emergence of the new coronavirus (COVID-19) pandemic has posed substantial obstacles to the smooth running of trauma services across the London trauma network. Trauma services have had to be re-configured due to considerable pressures placed on the network in order to facilitate the provision of medical care to the COVID-19 patient at the expense of a full functional trauma service [ 13 ]. Although trauma care remained a priority, several changes were implemented as a result of infrastructure demand from COVID-19, infection control measures, and staff absence due to either re-deployment or illness.…”

Section: Reviewmentioning

confidence: 99%

“…One of the major impacts of the current pandemic was the increasing constraint placed on the provision of surgery (both trauma and elective). In view of anaesthetic staff re-deployment and alteration of operating rooms as an extension to critical care, elective surgeries were postponed, and the threshold for trauma surgeries re-considered [ 13 ]. Recommended guidelines from the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) have advocated the conservative management of most upper limb fractures (including humeral, clavicle, and wrist fractures) with known high rates of union [ 15 ].…”

Section: Reviewmentioning

confidence: 99%

“…Recommended guidelines from the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) have advocated the conservative management of most upper limb fractures (including humeral, clavicle, and wrist fractures) with known high rates of union [ 15 ]. However, the drawback of this non-operative approach is a potential late displacement of fractures resulting in malunions or non-unions, which would subsequently require operative management at a later date [ 13 ].…”

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

The London Major Trauma Network System: A Literature Review

Beeharry¹,

Moqeem²

2020

Cureus

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“…The novel coronavirus SARS-CoV-2 disease (COVID-19) was declared a pandemic in March 2020. There became an urgent necessity to redistribute resources, optimize care flow pathways and reorganize staff, systems and space within all UK hospitals 1 . Major trauma services adjusted to reduced access to CT and had to restructure operative flow due to limited intensive care beds.…”

mentioning

confidence: 99%