The impact of SARS and COVID-19 on major trauma in Hong Kong

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases during the 2003 Severe Acute Respiratory Syndrome (SARS) period with COVID-19 in 2020. Methods Data were analyzed from the trauma registry of a major, tertiary-care teaching hospital in Hong Kong. Patients presenting with major traumatic injuries during the first six months of 2001–03 and 2018–20 were retrieved for analysis. Patient characteristics, injury mechanism, admitting service, and emergency department (ED)/hospital lengths of stay (LOS) were recorded. Raw and adjusted survival rates (using the modified Trauma Injury Severity Score (TRISS)) were recorded. Results The number of trauma cases fell dramatically during 2003 and 2020 compared with previous years. In both 2003 and 2020, the number of trauma registry patients fell by 49% in April (compared to the preceding reference years of 2001/02 and 2018/19, respectively). Patient characteristics, treatments, and outcomes were also different during the outbreak years. Comparing 2003 to 2020 relative to their respective reference baselines, the percentages of injuries that happened at home, patients without co-morbidities, and patients' mean age all increased in 2003 but decreased in 2020. Work-place injuries drastically dropped in 2003, but not in 2020. Average ED LOS dropped in 2003 by 36.4 min (95% CI 12.5, 60.3) but declined by only 14.5 min (95% CI -2.9, 32.1) in 2020. Both observed and expected 30-day mortality declined in 2020 vs. 2003 (observed 4.5% vs. 11.7%, p = 0.001, OR 0.352, 95% CI 0.187, 0.661) (expected 4.5% vs 11.6%, p = 0.002, OR 0.358, 95% CI 0.188, 0.684). Conclusion Major trauma cases dropped by half during both the peak of the 2003 SARS and 2020 COVID-19 pandemics in Hong Kong, suggesting a trend for future pandemic planning. If similar findings are seen at other trauma centers, proactive personnel and resource allocations away from trauma towards medical emergency systems may be more appropriate for future pandemics.

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

“…Some studies have reported a reduction in patient age during lockdown as well as an 8%−9.1% increase in male patients. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 19 20 ] In the present study, these changes were not statistically significant, supporting the published data from other studies. [ 6 10 11 18 21 ] Another important observation during the COVID-19 pandemic was a significantly prolonged time for patients to be transferred to the hospital.…”

“…[ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 19 20 ] In the present study, these changes were not statistically significant, supporting the published data from other studies. [ 6 10 11 18 21 ] Another important observation during the COVID-19 pandemic was a significantly prolonged time for patients to be transferred to the hospital. This could be due to increased concern for prehospital staff safety and the use of personal protective equipment (PPE).…”

“…Our findings of a 10% reduction in TT activations during the COVID-19 lockdown are consistent with those of two other studies performed in the USA and one from Hong Kong. [ 2 11 15 ] This is a logical finding and has a couple of possible explanations. One reason would be the stay-at-home order with closure of nonessential shops and businesses, entertainment venues, schools, and public events.…”

“…We observed a significant increase in trauma severity during the lockdown. The majority of published studies have reported no change or a decrease in trauma severity,[ 2 3 5 6 7 9 11 16 17 18 21 ] while a study by Chang et al . and WȨhnert et al .…”

“…[ 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. [ 12 ] In the European Union, Lithuania has the highest suicide rate (25.8 cases/100,000 inhabitants) and is among the top three countries with regard to the death rate due to road traffic accidents.…”