The ICON Trauma Study: the impact of the COVID-19 lockdown on major trauma workload in the UK

Abstract

Background The global pandemic caused by SARS-CoV-2 has impacted population health and care delivery worldwide. As information emerges regarding the impact of “lockdown measures” and changes to clinical practice worldwide; there is no comparative information emerging from the United Kingdom with regard to major trauma. Methods This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020–18/05/2020) to a historical cohort of patients admitted during a similar time period in 2019 (11/03/2019–20/05/2019). Differences in demographics, Clinical Frailty Scale, SARS-CoV-2 status, mechanism of injury and injury severity were compared using Fisher’s exact and Chi-squared tests. Univariable and multivariable logistic regression analyses examined the associated factors that predicted 30-days mortality. Results A total of 642 patients were included, with 405 in the 2019 and 237 in the 2020 cohorts, respectively. 4/237(1.69%) of patients in the 2020 cohort tested positive for SARS-CoV-2. There was a 41.5% decrease in the number of trauma admissions in 2020. This cohort was older (median 46 vs 40 years), had more comorbidities and were frail (p < 0.0015). There was a significant difference in mechanism of injury with a decrease in vehicle related trauma, but an increase in falls. There was a twofold increased risk of mortality in the 2020 cohort which in adjusted multivariable models, was explained by injury severity and frailty. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables. Conclusion Patients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality.

Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

“…Despite the limitations of our study, our work demonstrates the need for fast-track emergency surgical services during the pandemic to decrease time to operation and reduce post-operative complication severity. This has been described by other orthopaedic departments globally [25,26].…”

Falls Injuries and Anxiety among Community-Dwelling Older Adults in the Midst of COVID-19 Lockdown Restrictions: Are these Helpful or Harmful?

“…Although falls are common among older adults, the population most impacted by COVID-19, very few current publications address this topic specifically, especially from an anxiety perspective. However, even though Williams et al [27] noted no significant association between anxiety disorders and falls among prior fallers who were depressed in their study, as observed in a systematic review by Payette et al [28] and Almeida et al [18] who studied 41,098 community dwelling men and women, mean ages 70.0 ± 8.9 years, a falls prevalence of 8.2% that was noted was higher among those who were older, female, and frail. As well, those exhibiting evidence of multiple medication usage and/or fear of falling, plus those with falls related psychological concerns were more likely to fall than those who did not take multiple medications or have any falls associated fears.…”

“…Although not explicitly related to anxiety, it has also been shown in an observational study originating from a major United Kingdom trauma centre of patients admitted during a 10-week period starting in March 2020 who were compared to a historical cohort of patients admitted during a similar time period in 2019 that this current cohort was older and more frail with more comorbidities and an increased falls rate. There was also a twofold increase in the risk of mortality in the 2020 cohort, which was explained by injury severity and frailty, when all other variables were controlled [18].…”

Emergency surgery and trauma during COVID-19 pandemic: safe, smart and kind!

“…In one report from UK the trauma system itself had been even more overwhelmed by the fact that patients admitted during the COVID-19 pandemic were older, frailer and with higher co-morbidity with associated increased risk of mortality [ 6 ]; while due to reallocation of surgeons in other areas, in order of obligations to take different in-hospital tasks, and due to progressive transmission of the in novel coronavirus (2019-nCoV) among care providers, some surgeons had to take significantly more calls [ 14 ] struggling with burn-out.…”

“…Although the overall volume of injuries and cases with acute abdominal conditions admitted to the emergency department decreased due to lockdown and containment strategy, new challenges had to be managed [5][6][7][8]; skeletal trauma surgeons reported higher mortality rates in COVID-19 positive patients with hip fractures [9] and an increasing incidence proportion of emergency operations and severe open fractures [10], while emergency general surgeons, to spare resources and protect the population, had to modify their decision making process shifting towards a tailored conservative approach and struggled with more severe cases due to late presentation of patients with acute abdominal conditions [11][12][13].…”