Trauma center activity and surge response during the early phase of the COVID-19 pandemic—the Philadelphia story

Qasim, Zaffer; Sjoholm, Lars O.; Volgraf, Jill; Sailes, Stephanie; Nance, Michael L.; Perks, Diane H.; Grewal, Harsh; Meyer, Loreen K.; Walker, Janelle; Koenig, George; Donnelly, Julie; Gallagher, John J.; Kaufman, Elinore J.; Kaplan, Mark; Cannon, Jeremy W.

doi:10.1097/ta.0000000000002859

Cited by 67 publications

(109 citation statements)

References 26 publications

(12 reference statements)

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“…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.…”

Section: Resultsmentioning

confidence: 90%

“…The rise in assaults, domestic violence and NAI is likely a result of the well documented increase in domestic abuse and alcohol consumption. 41 , 69 , 70 Falls from less than 2 m continue to be the most common mechanism of injury in trauma, which generally occur in the elderly. 71 These injuries tend to occur indoors and therefore the stimulus for such injuries remains unchanged.…”

Section: Discussionmentioning

confidence: 99%

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

Waseem

Nayar

Hull

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Purpose; The COVID-19 pandemic has necessitated profound adaptations in the delivery of healthcare to manage a rise in critically unwell patients. In an attempt to slow the spread of the virus nationwide lockdown restrictions were introduced. This review aims to scope the literature on the impact of the pandemic and subsequent lockdown on the presentation and management of trauma globally. Methods; A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was carried out on the Medline, EMBASE and Cochrane databases to identify papers investigating presentation and management of trauma during the COVID-19 pandemic. All studies based on patients admitted with orthopaedic trauma during the COVID-19 pandemic were included. Exclusion criteria were opinion-based reports, reviews, studies that did not provide quantitative data and papers not in English. Results; Three hundred and thirty seven studies were screened, with 17 meeting the eligibility criteria. Studies reported on the footfall of trauma in the UK, Europe, Asia, USA, Australia and New Zealand. A total of 29,591 patients during the pandemic were considered. Mean age was 43.7 years (range <1–103); 54.8% were male. Reported reductions in trauma footfall ranged from 20.3% to 84.6%, with a higher proportion of trauma occurring secondary to interpersonal violence, deliberate self-harm and falls from a height. A decrease was seen in road traffic collisions, sports injuries and trauma occurring outdoors. There was no significant change in the proportion of patients managed operatively, and the number of trauma patients reported to be COVID-19 positive was low. Conclusion; Whilst the worldwide COVID-19 pandemic has caused a reduction in the number of trauma patients; the services managing trauma have continued to function despite infrastructural, personnel and pathway changes in health systems. The substantial effect of the COVID-19 pandemic on elective orthopaedics is well described, however the contents of this review evidence minimal change in the delivery of effective trauma care despite resource constraints during this global COVID-19 pandemic.

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Section: Resultsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

Waseem

Nayar

Hull

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…Our data are aligned with these previous findings. In Philadelphia, there was an increase in gun-related trauma during March 2020, despite overall decrease in trauma encounters in the ED [ 9 , 10 ]. Although their study did not show an increase in overall trauma, penetrating trauma, or NAT among pediatric trauma centers, they highlight the overall increased rates of interpersonal violence that was observed in other major cities in the United States.…”

Section: Discussionmentioning

confidence: 99%

Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital

Sanford

Zagory

Blackwell

et al. 2021

Journal of Pediatric Surgery

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Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our twoinstitution experience. Methods: Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015)(2016)(2017)(2018)(2019). Results: There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower ( p < 0.001) during COVID-19. Burn injury admissions ( p < 0.001) and penetrating trauma encounters ( p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased ( p < 0.001). Trauma occurred among more white ( p = 0.01) and privately insured ( p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes ( p < 0.001), pedestrians struck by automobile ( p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries ( p = 0.02), falls ( p < 0.001), and sports related injuries ( p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance ( p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era ( p = 0.04). For burn admissions, there was a significant increase in flame burns ( p < 0.001). Conclusions: Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.

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“…During the COVID-19 surge, we observed the previously described phenomenon where a decrease in surgical volume is compensated by an increase in the number of ICU patients. 6,8 Uniquely approaching the recent COVID-19 surge as a nonsurgical "mass casualty event" a data were available for 60 patients in pre-COVID and 95 patients in the surge group; # data presented for those who were on mechanical ventilation; SD, standard deviation; IQR, interquartile range; APACHE II, Acute Physiology and Chronic Health Evaluation II score; EGS, emergency general surgery ; ICU, intensive care unit; LOS, length of stay; AMA, against medical advice; Acuity 2019 predicted mortality was calculated based on MDN Phoenix database (Medical Decisions Network; Charlottesville, Virginia). 7 helped us to reallocate resources to clinical "hot spots" while continuing to provide adequate coverage across all patient populations managed by the ACS service.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] The COVID-19 pandemic has challenged health care systems and hospitals with an increased demand for both human and material resources and has presented a unique opportunity to test the performance of the ACS model during this nonsurgical catastrophic event. 6 During the COVID-19 surge in Boston from March to May 2020, the ACS service at an urban, tertiary, level I academic trauma center was assigned to continue coverage of all trauma, EGS, and SCC patients, with the added responsibility of taking care of critically ill nonsurgical patients including COVID-19 positive patients.…”

Section: Introductionmentioning

confidence: 99%

Acute Care Surgery Service Is Essential During a Nonsurgical Catastrophic Event, the COVID-19 Pandemic

Bugaev

Hojman

Breeze

et al. 2020

The American Surgeon™

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Background The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. Methods A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. Results Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% ( P = .99) for all critically ill patients; and 13.9% vs. 27.4% ( P = .12) for COVID-19 critically ill patients. Conclusion Acute care surgery is an “essential” service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services.

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Trauma center activity and surge response during the early phase of the COVID-19 pandemic—the Philadelphia story

Abstract: Supplemental digital content is available in the text.

Cited by 67 publications

References 26 publications

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

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

Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital

Acute Care Surgery Service Is Essential During a Nonsurgical Catastrophic Event, the COVID-19 Pandemic

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