Informing future policy for trauma prevention: The effect of the COVID-19 ‘National state of disaster lockdown’ on the trauma burden of a tertiary trauma centre in the Western Cape of South Africa

Mahoney, Scott H.; Steyn, E; Lategan, Hendrik

doi:10.1016/j.afjem.2021.06.002

Cited by 12 publications

(18 citation statements)

References 7 publications

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“…Tygerberg Hospital is the tertiary trauma (referral) center that provides specialty surgical and trauma care to a catchment area of 3.4 million people and attends to over 107,000 admissions annually of which 12,000–15,000 are seriously injured persons [ 35 , 36 ]. All other EpiC hospital sites (Khayelitsha, Ceres, and Worcester Hospitals) refer complex and critical trauma patients to Tygerberg Hospital for a full range of trauma subspecialty care and consultations [ 37 ].…”

Section: Methods and Designmentioning

confidence: 99%

“…Additionally, EpiC does not collect information for individuals that die during non-EMS transport to the hospital, which will potentially exclude individuals with extremely severe injuries from our analysis and will limit the generalizability of results to this population. Further, EpiC began enrollment during the COVID-19 pandemic when trauma caseloads across South Africa and in the Western Cape Province were reduced by up to 50% [ 36 ], which can result in the reporting of rates that are lower compared to pre-COVID periods.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa

Suresh

Dixon

Patel

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Deaths due to injuries exceed 4.4 million annually, with over 90% occurring in low-and middle-income countries. A key contributor to high trauma mortality is prolonged trauma-to-treatment time. Earlier receipt of medical care following an injury is critical to better patient outcomes. Trauma epidemiological studies can identify gaps and opportunities to help strengthen emergency care systems globally, especially in lower income countries, and among military personnel wounded in combat. This paper describes the methodology of the “Epidemiology and Outcomes of Prolonged Trauma Care (EpiC)” study, which aims to investigate how the delivery of resuscitative interventions and their timeliness impacts the morbidity and mortality outcomes of patients with critical injuries in South Africa. Methods The EpiC study is a prospective, multicenter cohort study that will be implemented over a 6-year period in the Western Cape, South Africa. Data collected will link pre- and in-hospital care with mortuary reports through standardized clinical chart abstraction and will provide longitudinal documentation of the patient’s clinical course after injury. The study will enroll an anticipated sample of 14,400 injured adults. Survival and regression analysis will be used to assess the effects of critical early resuscitative interventions (airway, breathing, circulatory, and neurologic) and trauma-to-treatment time on the primary 7-day mortality outcome and secondary mortality (24-h, 30-day) and morbidity outcomes (need for operative interventions, secondary infections, and organ failure). Discussion This study is the first effort in the Western Cape of South Africa to build a standardized, high-quality, multicenter epidemiologic trauma dataset that links pre- and in-hospital care with mortuary data. In high-income countries and the U.S. military, the introduction of trauma databases and registries has led to interventions that significantly reduce post-injury death and disability. The EpiC study will describe epidemiology trends over time, and it will enable assessments of how trauma care and system processes directly impact trauma outcomes to ultimately improve the overall emergency care system. Trial Registration: Not applicable as this study is not a clinical trial.

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Section: Methods and Designmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa

Suresh

Dixon

Patel

et al. 2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Following the ban on the sale and consumption of alcohol, there were reductions in alcohol-related health risks, particularly injuries (motor vehicle crashes, falls, drowning, firearms, assaults, violence and burns) and alcohol poisoning. 2 , 9 , 10 , 11 , 12 , 13 The Sentinel Trauma Report clearly shows that the lockdown regulations and alcohol ban effectively reduced the number of trauma presentations by 40% – 50%. 11 After lifting the alcohol ban, the absolute number of trauma cases requiring admission in the five hospitals (in the Western Cape) sampled over one month (June 2020) increased by 54.2% and the number of trauma deaths in the Eastern Cape province of South Africa increased by 307%.…”

Section: The Central Argumentmentioning

confidence: 99%

Alcohol ban during the COVID-19 pandemic lockdown: Lessons for preventing foetal alcohol spectrum disorder in South Africa

Adebiyi

Mukumbang²

2022

African Journal of Primary Health Care & Family Medicine

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During the two national lockdowns implemented in South Africa to curb the spread of the coronavirus disease 2019 (COVID-19) pandemic, the sale and consumption of alcoholic beverages were prohibited. There is observational evidence from the literature suggesting a drastic reduction in the emergency and trauma unit admissions in many South African hospitals and clinics with alcohol-related restrictions. This article explores the potential benefits of the restrictions placed on the sale and consumption of alcohol during the COVID-19 pandemic on preventing foetal alcohol spectrum disorder (FASD) in South Africa. Following the potential benefits of the alcohol bans, we recommended that the current South African national liquor policy and the 2012 South African government-drafted Bill for Control of Marketing of Alcoholic Beverages should be fully implemented and enforced. Furthermore, the ‘best buys’ by the World Health Organization (WHO) should be adapted (based on local evidence) and executed. Implementing the abovementioned policies can reduce alcohol abuse by limiting and regulating the manufacturing, distribution, advertising, sponsorship, promotion, physical availability and hours of sale of alcoholic beverages in South Africa.Contribution: This article shows that alcohol bans during the coronavirus disease 2019 (COVID-19) lockdown reduced the short-term effects of alcohol. We believe that this could be a game-changer for the prevention of FASD in South Africa and positively impact the incidence and prevalence of FASD. This piece provides evidence that policymakers, health practitioners and academics can use to continue advocating for stricter alcohol control measures in South Africa.

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“…The data proves that there may be social factors (transportation and alcohol) that can be addressed to reduce the amount of severe trauma experienced in South Africa, and as a result, ease some of the burden of this nefarious disease in our hospitals. Mahoney et al [22] suggest visible policing as well as alcohol restrictions as possible prevention strategies. Primary prevention with tighter gun laws and possible "stop and search" protocols may also assist with violence prevention.…”

Section: Study Relevance In Low To Middle Income Countriesmentioning

confidence: 99%

“…Current government initiatives fall short of protecting the city from significant trauma. Mahoney et al [22] highlight that young working-class males are the most vulnerable to trauma, and their loss to society may also have detrimental socio-economic effects on the country. As such, a deeper investigation into governance and policing is urgently required to fully explore if primary prevention against trauma is feasible in South Africa.…”

Section: Study Relevance In Low To Middle Income Countriesmentioning

confidence: 99%

Effect of the Covid-19 Lockdown Regulations on the Severe Trauma Burden in an Urban Trauma Centre in Johannesburg, South Africa

2022

J Surg

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Background: During the Covid-19 pandemic, the South African government introduced stringent lockdown restrictions. Social restrictions affected patient presentation to hospitals with non-Covid related illnesses. Objectives:The aim of this research is to investigate the effect of lockdown on the major trauma presentation in a level one trauma centre in Johannesburg, as well as to assess how lockdown affected emergency and semi-emergency trauma surgical procedures.Method: This is a retrospective data analysis of major trauma patients presenting to Charlotte Maxeke Johannesburg Academic Hospital between 26 March to 13 July 2020 and 2019. The Medibank records of priority one patients presenting to the hospital over the time period were reviewed, and data were analysed per level of lockdown-patient demographics, day of the week on presentation, mechanism of injury and patient discharge destination from casualty were recorded. Injury Severity Scores (ISS) were calculated based on presenting injuries, imaging and intra-operative findings. All emergency and semi-emergency procedures over this time were also analysed. The 2019 and 2020 Data was compared, and statistical differences were calculated. A p-value of <0.05 was considered statistically significant.Results: An analysis of 1060 patients split between 595 patients in 2019 and 465 in 2020 was made. Level 5 lockdown had statistically significantly fewer priority one trauma case presentations in 2020 than 2019 (p=0.000), Level 4 had no statistically relevant change in patient number presenting to hospital, and Level 3 had statistically significant more priority one patients presenting in 2020 compared to 2019 (p=0.000). Penetrating trauma was persistently the most common mechanism of injury in both years, with a statistically significant reduction in train-related injuries in 2020 (p=0.011) and slightly more 'fall from heights' in 2020 (p-0.033). Fewer weekend and public holiday major trauma presentations occurred during the lockdown in 2020 (p= 0.003 and p=0.001 respectively) compared to 2019. Less emergency/ semi-emergency trauma surgeries were performed in 2020 in contrast to 2019 (p=0.000). Core Exam Technique Principles Conclusion:The results show a decline in major trauma presentation during the most limiting lockdown restrictions (Level 5) with a rebound increase in trauma during more relaxed lockdown regulations (Level 3). Lockdown shifted the presentation of major trauma to predominantly weekdays. There was a decline in surgical emergency and semi-emergency procedures but no change in overall ISS. The data highlights the diversity and complexity of trauma in Johannesburg, with difficulty in identifying primary prevention strategies.

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Informing future policy for trauma prevention: The effect of the COVID-19 ‘National state of disaster lockdown’ on the trauma burden of a tertiary trauma centre in the Western Cape of South Africa

Cited by 12 publications

References 7 publications

The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa

The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa

Alcohol ban during the COVID-19 pandemic lockdown: Lessons for preventing foetal alcohol spectrum disorder in South Africa

Effect of the Covid-19 Lockdown Regulations on the Severe Trauma Burden in an Urban Trauma Centre in Johannesburg, South Africa

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