The impact of SARS-CoV-2 (COVID-19) pandemic on trauma bay management and guideline adherence in a European level-one-trauma centre

Abstract

Purpose SARS CoV-2 (COVID-19) represents a pandemic that has led to adjustments of routine clinical practices. The initial management in the trauma bay follows detailed international valid algorithms. This study aims to work out potential adjustments of trauma bay algorithms during a global pandemic in order to reduce contamination and to increase safety for patients and medical personnel. Methods This retrospective cohort study compared patients admitted to the trauma bay of one academic level-one trauma centre in March and April 2019 with patients admitted in March and April 2020. Based on these datasets, possible adjustments of the current international guidelines of trauma bay management were discussed. Results Group Pan (2020, n = 30) included two-thirds the number of patients compared with Group Ref (2019, n = 44). The number of severely injured patients comparable amongst these groups: mean injury severity score (ISS) was significantly lower in Group Pan (10.5 ± 4.4 points) compared with Group Ref (15.3 ± 9.2 points, p = 0.035). Duration from admission to whole-body CT was significantly higher in Group Pan (23.8 ± 9.4 min) compared with Group Ref (17.3 ± 10.7 min, p = 0.046). Number of trauma bay admissions decreased, as did the injury severity for patients admitted in March and April 2020. In order to contain spreading of SARS Cov-2, the suggested recommendations of adjusting trauma bay protocols for severely injured patients include (1) minimizing trauma bay team members with direct contact to the patient; (2) reducing repeated examination as much as possible, with rationalized use of protective equipment; and (3) preventing potential secondary inflammatory insults. Conclusion Appropriate adjustments of trauma bay protocols during pandemics should improve safety for both patients and medical personnel while guaranteeing the optimal treatment quality. The above-mentioned proposals have the potential to improve safety during trauma bay management in a time of a global pandemic.

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

“…There was a worldwide reduction of between 20.3% and 84.6% in trauma patients compared to a pre-COVID control period. 10 , 11 , 12 , 13 , 14 , 15 , 17 , 19 , 20 , 25 , 27 , 34 , 35 , 37 , 41 , 42 , 43 , 44 , 45 , 46 Hernigou et al 16 reported a concomitant increase in paediatric trauma and reduction in adult trauma during the pandemic at their centre in Belgium, a finding replicated in one Australian centre. 47 Additionally, Wong et al‘s centre based in Australia reported no change in paediatric trauma requiring acute admission.…”

“…The mean age was reported for 3236 patients and was 43.7 years. 13 , 18 , 19 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 An average of 54.8% were male.…”

“… 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 …”

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

“…COVID-19 had a serious impact on healthcare systems, including workforce issues, procedural prioritization, and the constant risk of viral transmission [2] . Many authors identified issues to address surgical practice to improve safety for patients and medical personnel [3] , [4] , [5] .…”

Impact of the COVID-19 lockdown on trauma team activations in a single major Lithuanian trauma center

“…Only a few studies have reported the impact of the pandemic on trauma bay activity. [ 2 3 4 5 6 7 ] The data also vary from country to country regarding the type and mechanism of injury as well as injury severity. [ 8 9 10 11 ] Trauma remains among the top ten leading causes of death in low- and middle-income countries.…”