The Effect on Trauma Care Secondary to the COVID-19 Pandemic

Haut, Elliott R.; Leeds, Ira L.; Livingston, David H.

doi:10.1097/sla.0000000000004105

Cited by 50 publications

(63 citation statements)

References 12 publications

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“…1 Although these recommendations did not apply to urgent/emergent trauma surgeries, the shift of resources towards treating COVID-19 patients during the surge had the potential to leave the trauma system under-resourced. 2 , 3 Many anaesthetists and operating practitioners were pulled away to cover intensive care units (ICU) resulting in reduced capacity for surgery and non-COVID-19 patient care. Despite observations that showed reduced emergency department admissions likely due to stay-at-home orders, 4 , 5 , 6 the necessity of caring for hip fractures in the elderly remained a concern.…”

Section: Introductionmentioning

confidence: 99%

Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Zhong

Poeran

Liu

et al. 2021

British Journal of Anaesthesia

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Introduction The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on COVID-19’s impact on hip fractures, seen mainly in elderly patients. Using national claims data, we aimed to describe the epidemiology during the first US COVID-19 wave in the United States. Methods We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19 positive and negative patients. Outcomes included length of hospital stay (LOS), admission to an intensive care unit (ICU), ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition and a composite variable of post-operative complications. Results Overall, 16,068 hip fractures were observed in 2019 compared to 7,498 in 2020. Hip fracture patients in 2020 (compared to 2019), experienced earlier hospital discharge, were less likely to be admitted to ICU but more likely to be admitted to home. Among 83 hip fracture patients with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates, compared with COVID-19 negative patients. Conclusion The COVID-19 pandemic significantly impacted not only volume of hip fractures but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations such as those experiencing a hip fracture.

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Section: Introductionmentioning

confidence: 99%

Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Zhong

Poeran

Liu

et al. 2021

British Journal of Anaesthesia

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“…To reduce the amount of PPE used, including masks or respirators, 83% of hospitals clustered patient contact. Haut et al 1 18 also suggested to reduce the number of times clinicians round on patients at bedside to reduce the donning and doffing of PPE for each patient. Although nationwide shortages of PPE have been reported, this study found that only 17% of trauma centers experienced a shortage of PPE, having their orders diverted to other hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Although nationwide shortages of PPE have been reported, this study found that only 17% of trauma centers experienced a shortage of PPE, having their orders diverted to other hospitals. 8 , 9 , 17 , 18 Another study reported that 30% of practitioners in Lombardy, Italy, one of the most severely hit regions, stated that PPE supplies were insufficient. 7 This smaller proportion in need of masks could be in part because of the processes implemented on reuse and decontamination of masks or because of the high case volumes seen in Italy.…”

Section: Discussionmentioning

confidence: 99%

Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic

et al. 2021

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Introduction: As the COVID-19 pandemic spread, patient care guidelines were published and elective surgeries postponed. However, trauma admissions are not scheduled and cannot be postponed. There is a paucity of information available on continuing trauma care during the pandemic. The study purpose was to describe multicenter trauma care process changes made during the COVID-19 pandemic. Methods: This descriptive survey summarized the response to the COVID-19 pandemic at six Level I trauma centers. The survey was completed in 05/2020. Questions were asked about personal protective equipment, ventilators, intensive care unit (ICU) beds, and negative pressure rooms. Data were summarized as proportions. Results: The survey took an average of 5 days. Sixty-seven percent reused N-95 respirators; 50% sanitized them with 25% using ultraviolet light. One hospital (17%) had regional resources impacted. Thirty-three percent created ventilator allocation protocols. Most hospitals (83%) designated more beds to the ICU; 50% of hospitals designated an ICU for COVID-19 patients. COVID-19 patients were isolated in negative pressure rooms at all hospitals. Conclusions: In response to the COVID-19 pandemic, Level I trauma centers created processes to provide optimal trauma patient care and still protect providers. Other centers can use the processes described to continue care of trauma patients during the COVID-19 pandemic.

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“…This coupled with shortages of personal protective equipment and a restricted number of personnel, serves as a healthcare dilemma. 7 …”

Section: Introductionmentioning

confidence: 99%

Changes in trends during the COVID-19 lockdown: An urban, Level-1 trauma center's experience

Jaber

Bryan

et al. 2021

The American Journal of Surgery

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Background A community lockdown has a profound impact on its citizens. Our objective was to identify changes in trauma patient demographics, volume, and pattern of injury following the COVID-19 lockdown. Methods A retrospective review was conducted at a Level-1 Trauma Center from 2017 to 2020. Results A downward trend in volume is seen December–April in 2020 (R 2 = 0.9907). February through April showed an upward trend in 2018 and 2019 (R 2= 0.80 and R 2 = 0.90 respectively), but a downward trend in 2020 (R 2 = 0.97). In April 2020, there was 41.6% decrease in total volume, a 47.4% decrease in blunt injury and no decrease in penetrating injury. In contrast to previous months, in April the majority of injuries occurred in home zip codes. Conclusions A community lockdown decreased the number of blunt trauma, however despite social distancing, did not decrease penetrating injury. Injuries were more likely to occur in home zip codes.

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The Effect on Trauma Care Secondary to the COVID-19 Pandemic

Cited by 50 publications

References 12 publications

Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review

Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic

Changes in trends during the COVID-19 lockdown: An urban, Level-1 trauma center's experience

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