Quality of care was not compromised during the COVID‐19 pandemic at a level 1 trauma centre

Abstract

Background The COVID‐19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 Adult Major Trauma Service, and a designated COVID‐19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response. Methods The population of interest was all trauma patients captured in the hospital's Trauma Registry from March 16 th ‐September 10 th , 2016‐2020. Regression modelling assessed changes in mechanism and severity of the injury, and mortality during two lockdowns compared with the proceeding four years. Cases were matched with Hospital Administrative databases, to assess median time from admission to emergency CT scan, operating theatre, length of stay, and immediate surgery (OPSTAT). Results Throughout 2020, the hospital treated 525 COVID‐19 patients. Compared with previous years, there was up to a 34% reduction in major trauma and a 28% reduction in minor trauma admissions during the pandemic (p<0.05). ICU admissions were almost half of predicted. Some of the largest reductions were seen in motor vehicle crashes (49%) and falls (28%) (p<0.05). Time to CT, surgery and immediate surgery (OPSTAT) showed no change and having a suspected COVID‐19 diagnosis did not prolong any of these times except for the length of stay. Mortality was similar to previous years. Conclusion The COVID‐19 pandemic has had widespread societal changes, resulting in a substantial decrease in trauma presentations. Despite COVID's immense impact on the hospital's trauma service, the quality of care was not impaired.

What effect did the New Zealand COVID‐19 lockdown have on computed tomography‐head scan utilisation in patients presenting to the emergency department with traumatic head injuries?

“…3 This is consistent with international data from Australian, Canadian and European centres where the incidence of TBI presentations to the ED significantly reduced. 5,[8][9][10] It is not possible to say with certainty from our data if the total number of head injuries in the community decreased during the lockdown period, or the same number occurred, but people avoided presenting to the ED during the lockdown. However, as the proportions of head injury presentations, CT-head request rates and CT-heads demonstrating positive findings remained the same, it is certainly plausible to interpret this as a reduction in the total number of injuries.…”

“…There were notable reductions in patient volume and traumatic ED presentations internationally and locally in New Zealand (NZ). [2][3][4][5] Traumatic brain injury (TBI) is a common ED presentation, with international EDs reporting escalating computed tomography (CT)head use in increasingly crowded…”

Victoria's surgical response to the COVID‐19 pandemic: the first two years

“…Patients with surgical conditions still presented to the emergency department, despite initial fears that the pandemic would discourage patients from seeking medical care 2 . Studies demonstrated significantly less road accidents with varying reports on changes in assaults, home injuries and domestic violence 70–73 . The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), demonstrated a decrease in the overall number of trauma admissions (6890 in FY18‐19 compared with 6528 in FY19‐20) 74 .…”

“…2 Studies demonstrated significantly less road accidents with varying reports on changes in assaults, home injuries and domestic violence. [70][71][72][73] The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), demonstrated a decrease in the overall number of trauma admissions (6890 in FY18-19 compared with 6528 in FY19-20). 74 There was also a decrease in motor vehicle accidents.…”

The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic

“…First, reductions in donor referrals of 12%–39% were reported in 2020. 9 , 10 National lockdowns and travel restrictions resulted in a reduction in major trauma and road traffic accidents, 11 , 12 and in some locations, patients were hesitant to seek medical attention for other critical conditions—perhaps relating to fear of burdening already stretched healthcare systems or of contracting SARS-CoV-2 infection themselves. 13 Intensive care units were caring for a different population, evidenced by a 4.5% reduction in donors dying from trauma, 25% reduction in donors dying from road traffic accidents, and 35% increase in donors dying from substance abuse over the first wave of the pandemic.…”