Trauma Trends During the Initial Peak of the COVID-19 Pandemic in the Midst of Lockdown: Experiences From a Rural Trauma Center

Rhodes, Heather; Petersen, Kirklen; Biswas, Saptarshi

doi:10.7759/cureus.9811

Cited by 46 publications

(68 citation statements)

References 9 publications

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“…A staggering 59% reduction in the total admissions for the lockdown period compared to the historical period was observed. Similar dramatic decreases in trauma cases, from 37.6 to 57.4%, have been reported worldwide (Leichtle et al 2020;Kamine et al 2020;Jacob et al 2020;Comelli et al 2020;Nuñez et al 2020;Christey et al 2020;Morris et al 2020;Rajput et al 2020;Rhodes et al 2020;Navsaria et al 2020). Aside from the lockdown and curfew orders, fear of contracting COVID-19 while seeking medical attention, for both traumatic and even non-traumatic injuries, has also been cited as a possible reason for the universal decrease in admissions (Navsaria et al 2020;Leichtle et al 2020;Rajput et al 2020).…”

Section: Discussionsupporting

confidence: 74%

“…Despite stringent restrictions on social and public life, patients still experience trauma. Although the COVID-19 pandemic still an on-going issue, the few reports related to its effect on trauma suggest that there has been a considerable reduction in the number of admissions and, in some cases, a change in the mechanisms of injury for which the patients require medical assistance (Leichtle et al 2020;Kamine et al 2020;Jacob et al 2020;Comelli et al 2020;Nuñez et al 2020;Christey et al 2020;Morris et al 2020;Rajput et al 2020;Rhodes et al 2020;Navsaria et al 2020). The primary objective of this study was to determine the effect of the COVID-19 pandemic and the associated lockdown on trauma admissions, as well as their influence on patient's demographics, mechanisms of injury, injury severity, and outcomes to the Puerto Rico Trauma Hospital (PRTH).…”

Section: Introductionmentioning

confidence: 99%

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The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

et al. 2021

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Background The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital. Methods An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05. Results A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS. Conclusions Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

et al. 2021

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“…This is supported by the trend observed by Rhodes, Petersen, and Biswas in the setting of a rural trauma center who reported that ISS scores did not significantly change after the pandemic. 12 There was a significant increase in the mean length of stay after COVID-19 but no change in the median length of stay. This finding cannot be fully explained by the data set, but it is possible that some patients have higher rates of complications, either infectious or otherwise following the pandemic.…”

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

The Effects of the COVID-19 Pandemic on Trauma Presentations in a Level One Trauma Center

Devarakonda

Wehrle

Chibane

et al. 2020

The American Surgeon

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Background Over 28 million confirmed cases of COVID-19 have been reported to date, resulting in over 900 000 deaths. With an increase in awareness regarding the virus, the behavior of general population has changed dramatically. As activities such as driving and hospital presentation patterns have changed, our study aimed to assess the differences in trauma case variables before and during the COVID-19 pandemic. Methods Trauma data for the period of March 1st-June 15th were compared for the years 2015-2019 (pre-COVID) and 2020 (COVID). The data were analyzed across the following categories: injury severity score, injury mechanism, motor vehicle crashes (MVCs) vs. other blunt injuries, alcohol involvement, and length of hospital stay. Results The median injury severity score pre-COVID and during COVID was 9, representing no change. There was no difference in overall distribution of mechanism of injury; however, there was a significant decrease in the percentage of MVCs pre-COVID (36.39%) vs. COVID (29.6%, P < .05). Alcohol was significantly more likely to be involved in trauma during COVID-19 ( P < .05). The mean hospital stay increased from 3.87-5.4 days during COVID-19 ( P < .05). Discussion We saw similar results to prior studies in terms of there being no change in trauma severity. Our observation that motor vehicle collisions have decreased is consistent with current data showing decreased use of motor vehicles during the pandemic. We also observed an increase in alcohol-related cases which are consistent with the reported changes in alcohol consumption since the pandemic began.

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“… 48 Of the 7 studies reporting the injury severity score (ISS) of patients presenting during the pandemic, 5 reported a similar or slightly reduced presenting ISS during the pandemic, when compared with pre-pandemic years. 34 , 40 , 49 , 50 , 51 However, 2 centres in the United States (US) reported an increase in presenting ISS of 13.7–33%. 29 , 52 …”

Section: Resultsmentioning

confidence: 99%

The global burden of trauma during the COVID-19 pandemic: A scoping review

Waseem

Nayar

Hull

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Purpose; The COVID-19 pandemic has necessitated profound adaptations in the delivery of healthcare to manage a rise in critically unwell patients. In an attempt to slow the spread of the virus nationwide lockdown restrictions were introduced. This review aims to scope the literature on the impact of the pandemic and subsequent lockdown on the presentation and management of trauma globally. Methods; A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was carried out on the Medline, EMBASE and Cochrane databases to identify papers investigating presentation and management of trauma during the COVID-19 pandemic. All studies based on patients admitted with orthopaedic trauma during the COVID-19 pandemic were included. Exclusion criteria were opinion-based reports, reviews, studies that did not provide quantitative data and papers not in English. Results; Three hundred and thirty seven studies were screened, with 17 meeting the eligibility criteria. Studies reported on the footfall of trauma in the UK, Europe, Asia, USA, Australia and New Zealand. A total of 29,591 patients during the pandemic were considered. Mean age was 43.7 years (range <1–103); 54.8% were male. Reported reductions in trauma footfall ranged from 20.3% to 84.6%, with a higher proportion of trauma occurring secondary to interpersonal violence, deliberate self-harm and falls from a height. A decrease was seen in road traffic collisions, sports injuries and trauma occurring outdoors. There was no significant change in the proportion of patients managed operatively, and the number of trauma patients reported to be COVID-19 positive was low. Conclusion; Whilst the worldwide COVID-19 pandemic has caused a reduction in the number of trauma patients; the services managing trauma have continued to function despite infrastructural, personnel and pathway changes in health systems. The substantial effect of the COVID-19 pandemic on elective orthopaedics is well described, however the contents of this review evidence minimal change in the delivery of effective trauma care despite resource constraints during this global COVID-19 pandemic.

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Trauma Trends During the Initial Peak of the COVID-19 Pandemic in the Midst of Lockdown: Experiences From a Rural Trauma Center

Cited by 46 publications

References 9 publications

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

The Effects of the COVID-19 Pandemic on Trauma Presentations in a Level One Trauma Center

The global burden of trauma during the COVID-19 pandemic: A scoping review

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