Trauma care during the COVID-19 pandemic in the Netherlands: a level 1 trauma multicenter cohort study

Abstract

Purpose The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment. The influence of the pandemic on the burden of disease of trauma care remains to be elucidated. Methods All patients with traumatic injuries that were presented to the emergency departments (ED) of the Amsterdam University Medical Center, Location Academic Medical Center (AMC) and VU medical center (VUMC) and the Northwest Clinics (NWC) between March 10, 2019 and May 10, 2019 (non-COVID) and March 10, 2020 and May 10, 2020 (COVID-19 period) were included. The primary outcome was the difference in ED admissions for trauma patients between the non-COVID and COVID-19 study period. Additionally, patient- and injury characteristics, health care consumption, and 30-day mortality were evaluated. Results A 37% reduction of ED admissions for trauma patients was seen during the COVID-19 pandemic (non-COVID n = 2423 and COVID cohort n = 1531). Hospital admission was reduced by 1.6 trauma patients per day. Fewer patients sustained car- and sports-related injuries. Injuries after high energetic trauma were more severe in the COVID-19 period (Injury Severity Score 17.3 vs. 12.0, p = 0.006). Relatively more patients were treated operatively (21.4% vs. 16.6%, p < 0.001) during the COVID-19 period. Upper-(17.6 vs. 12.5%, p = 0.002) and lower extremity injuries (30.7 vs. 23.0%, p = 0.002) mainly accounted for this difference. The 30-day mortality rate was higher during the pandemic (1.0 vs. 2.3%, p = 0.001). Conclusion The burden of disease and healthcare consumption of trauma patients remained high during the COVID-19 pandemic. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks.

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

“…Compared to the pre-Covid-19 era, there was a significant reduction between 12.2% and 69.75% of patients presenting to trauma departments [ 40 – 48 ]. Three studies showed no significant reductions of major trauma, defined as an injury severity score (ISS) of greater than 15 [ 42 , 44 , 48 ]. In one study, significantly more polytrauma patients were reported during the Covid-19 period [ 42 ].…”

“…Three studies showed no significant reductions of major trauma, defined as an injury severity score (ISS) of greater than 15 [ 42 , 44 , 48 ]. In one study, significantly more polytrauma patients were reported during the Covid-19 period [ 42 ]. Road Traffic Collisions (RTCs), in the 2020 baseline time, accounted for 12.0 to 31.2% of trauma call activations.…”

“…The number of patients with intentional injuries admitted to the active level 1 trauma centers was greatly increased during the lockdown and this result would merit further analysis to assess the role of pre-existing factors and their interaction with the imposed restrictions. An increase in centralization to fewer facilities with high level of care obtained satisfactory results in the capability of the health system to take care of trauma emergencies while Covid-19 patients overwhelmed resources of most hospitals Hakkenbrak et al, 2021 [ 42 ] Scand J Trauma Resusc Emerg Med Retrospective cohort Netherlands The overall in-hospital healthcare consumption was only marginally reduced and the number of surgically treated patients relatively increased. More severely injured patients and a higher percentage of patients in need for hospital admission were observed.…”

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.…”

Resilience in health care, important for anesthesia and intensive care

“…Health system resilience describes the capacity of a health system to (a) proactively foresee, (b) absorb, and (c) adapt to shocks and structural changes in a way that allows it to (i) sustain required operations, (ii) resume optimal performance as quickly as possible, (iii) transform its structure and functions to strengthen the system, and (iv) (possibly) reduce its vulnerability to similar shocks and structural changes in the future. reduction of most common patient groups requiring acute hospital admission care such as trauma, 6 cardiac emergencies, COPD exacerbations and infectious diseases, 7 acting as a buffer so that the system was not completely overwhelmed and was able to sustain emergency surgeries.…”