Changes in Pediatric Non-accidental Trauma Emergency Department Visits During and Following the COVID-19 Lockdown.

A level 1 pediatric trauma registry database was examined for all non-accidental trauma (NAT) emergency department visits between 2016 and 2021, and average injury severity score assigned to those patients with physical injuries over 2019-2021. There was a decline in NAT visits in 2020 (267) from prior years (343 visits average over 2016-2019), with subsequent increase in 2021 (548). Injury severity score increased (ISS) in 2020 (7.3) when compared to 2019 (5.71), with a decline in average ISS in 2021 (5.42). This data highlights the potential for missed abuse during closures with increased detection following reopening. Our data regarding ISS demonstrates the pediatric population is at risk of more severe abuse during times of familial stress. We need increased awareness that periods of vulnerability to NAT exist, as seen during the COVID-19 pandemic.

Comparison of Trauma and Burn Evaluations in a Pediatric Emergency Department During Pre, Early and Late COVID-19 Pandemic.

BACKGROUND: Pediatric trauma epidemiology altered during early COVID-19 pandemic period but the impact of the ongoing pandemic is unknown. OBJECTIVES: To compare pediatric trauma epidemiology between the pre, early and late pandemic periods and to evaluate the association of race and ethnicity on injury severity during the pandemic. METHODS: We performed a retrospective study of trauma consults for an injury/burn in children ≤16 years between January 1, 2019 and December 31, 2021. Study period was categorized into pre (January 1, 2019-February 28, 2020), early (March 1, 2020-December 31, 2020), and late (January 1, 2021-December 31, 2021) pandemic. Demographics, etiology, injury/burn severity, interventions and outcomes were noted. RESULTS: A total of 4940 patients underwent trauma evaluation. Compared to pre-pandemic, trauma evaluations for injuries and burns increased during both the early (RR: 2.13, 95% CI: 1.6-2.82 and RR: 2.24, 95% CI: 1.39-3.63, respectively) and late pandemic periods (RR: 1.42, 95% CI: 1.09-1.86 and RR: 2.44, 95% CI: 1.55-3.83, respectively). Severe injuries, hospital admissions, operations and death were higher in the early pandemic but reverted to pre-pandemic levels during late pandemic. Non-Hispanic Blacks had an approximately 40% increase in mean ISS during both pandemic periods though they had lower odds of severe injury during both pandemic periods. CONCLUSIONS: Trauma evaluations for injuries and burns increased during the pandemic periods. There was a significant association of race and ethnicity with injury severity which varied with pandemic periods. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a major and costly public health emergency. AIM: To investigate the impact of China's lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine. METHODS: All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled. We collected data on demographics, daily visits, injury type, injury mechanism, injury severity score, and patient management for comparative analysis. RESULTS: The total number of patients in the trauma center of our hospital decreased by 50.38% during the COVID-19 Lockdown in 2020 compared to the same period in 2019. The average number of trauma visits per day in 2019 was 47.94, compared to 23.79 in 2020. Comparing the patients' demographic data, loss of employment was the most predominate characteristic in 2020 compared to 2019, while there was no significant difference in gender, age, and marital status between both periods. During the lockdown period, the proportion of traffic accident-related injuries, injuries due to falls greater than 1.5 m, and mechanical injuries decreased significantly, whereas the proportion of injuries caused by falls less than 1.5 m, cuts, assault, bites, and suicidal tendencies and other injuries increased relatively. In addition, the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown. The hospitalization rate increased significantly, and there was no significant difference in emergency surgery and death rates. CONCLUSION: The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital, which can be monitored regularly. Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries. Emergency surgery and mortality rates remain high, increased because of factors such as family injury and penetrating injury, and hospitalization rates have increased significantly. Therefore, our trauma center still needs to be fully staffed. Finally, from the perspective of the injury mechanism, indoor trauma is a major risk during a lockdown, and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Clinical and functional characteristics of the post-COVID period (6-month follow-up).

Respiratory symptoms and functional disorders are registered in patients who suffered from COVID-19 (COronaVIrus Disease 2019). Aim. Clinical and functional evaluation of the respiratory system during 6-month follow-up in patients who had moderate and severe COVID-19. Methods. 80 patients were included in the cohort observational prospective study. Patients were examined in 46 (36 - 60) days from the onset of symptoms of COVID-19 and in 93 (89 - 103) and 180 (135 - 196) days at the 2nd and 3rd stages respectively. At all stages, symptoms, dyspnea level, and quality of life were analyzed using validated questionnaires, and a 6-minute step test was performed. At the 2nd and 3rd stages, we assessed spirometric parameters, total lung capacity, carbon monoxide diffusing capacity (DLCO), and high resolution computed tomography scans of chest organs. Results. At the 1st stage of the study, 62% of patients complained of fatigue, muscle weakness, 61% of patients had dyspnea of variable severity. At the 3rd stage of the study, 43% and 42% of patients had the same complaints respectively. The prevalence of moderate COVID-19 form in patients with 35 (25 - 45)% lung damage and severe COVID-19 form with 75 (62 - 75)% of lung damage was established. At the 2nd stage, a DLCO < 80% level was recorded in 46% of patients with 35 (25 - 45)% lung damage and in 54% of patients with 75 (62 - 75)%. At the 3rd stage, DLCO < 80% was diagnosed in 51.9% and 48.1% of patients with of 35 (25 - 45)% and 75 (62 - 75)% lung damage respectively. The level of DLCO < 60% was found in 38,5% and 35,5% of patients with moderate and severe lung damage at the 2nd and 3rd stages of the study respectively. Conclusion. The symptoms were reported less frequently during the 6-month follow-up after COVID-19. 77% and 87% of patients had DLCO < 80% in 93 (89 - 103) and 180 (135 - 196) days after the disease onset, respectively. 38.5% and 35.5% of those patients, predominantly having suffered COVID-19 in severe form, had DLCO < 60% at 93 (89 - 103) and 180 (135 - 196) days, respectively. This calls for a continuous observation and regular examinations after COVID-19.Copyright © 2022 Leshchenko I.V., Glushkova T.V.

Effect of COVID-19 Pandemic on Major Trauma Treated at a Level I Trauma Centre.

PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS >= 16) treated at our Level I Trauma Centre in the period 2018-2019 ("pre-COVID-19 time") and 2020-2021 ("COVID-19 time"). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the "pre-COVID-19 time" 399 patients were treated, while in the "COVID-19 time" it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with trau-matic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) >= 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the "COVID-19 time", the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients.Copyright © 2022, Galen s.r.o.. All rights reserved.

Evidence of sample selectivity in highway injury-severity models: The case of risky driving during COVID-19

Research in highway safety continues to struggle to address two potentially important issues;the role that unobserved factors may play on resulting crash and injury-severity likelihoods, and the issue of identification in safety modeling caused by the self-selective sampling inherent in commonly used safety data (the fact that drivers in observed crashes are not a random sample of the driving population, with riskier drivers being over-represented in crash data bases). This paper addresses unobserved heterogeneity using mixing distributions and attempts to provide insight into the potential sample-selection problem by considering data before and during the COVID-19 pandemic. Based on a survey of vehicle usage (vehicle miles traveled) and subsequent statistical modeling, there is evi-dence that riskier drivers likely made up a larger proportion of vehicle miles traveled dur-ing the pandemic than before, suggesting that the increase in injury severities observed during COVID-19 could potentially be due to the over-representation of riskier drivers in observed crash data. However, by exploring Florida crash data before and during the pan-demic (and focusing on crashes where risky behaviors were observed), the empirical anal-ysis of observed crash data suggests (using random parameters multinomial logit models of driver-injury severities with heterogeneity in means and variances) that the observed increase in injury severity during the COVID-19 pandemic (calendar year 2020) was likely due largely to fundamental changes in driver behavior and less to changes in the sample selectivity of observed crash data. The findings of this paper provide some initial guidance to future work that can begin to more rigorously explore and assess the role of selectivity and resulting identification issues that may be present when using observed crash data.(c) 2022 Elsevier Ltd. All rights reserved.

The Feasibility of Ecmo before Mechanical Ventilation for Severe Respiratory Failure Due to Covid-19

INTRODUCTION: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is typically used to support severe ARDS after the failure of invasive mechanical ventilation (IMV). IMV may cause harm in patients with preexisting barotrauma, shock, or immune compromise. METHOD(S): Single center case-control study of VV-ECMO before IMV (awake ECMO;n=24) compared to conventional ECMO (n=76) after IMV in COVID-19 patients. Groups were compared at baseline before cannulation (awake ECMO) or intubation (conventional ECMO). Propensity matching was performed based on body mass index and injury severity (Simplified Acute Physiology Score II [SAPS II], PaO2:FiO2 ratio). The primary outcome was survival to discharge. Secondary measures of duration of IMV and adverse events were examined. Multivariable adjustments were performed. RESULT(S): Awake ECMO compared to conventional ECMO patients at baseline were more tachypneic (mean +/- standard deviation: 36.3 +/- 9.6 vs 27.4 +/- 7.3;p< 0.0001) with lower SpO2 (median [interquartile range]: 87% [81-92.5] vs 93% [87-96];p=0.01) but similar SAPS II. Fifteen (68%) of awake ECMO patients eventually required IMV. Survival to discharge in awake ECMO trended towards improvement compared to conventional ECMO (70.8% vs. 52.6%;p=0.12). After propensity matching, awake ECMO was associated with increased survival (adjusted odds ratio 6.84 [95% confidence interval 1.08 - 43.38]). Awake ECMO was associated with less duration of IMV before and after propensity matching. Adverse events were similar between groups. CONCLUSION(S): Awake ECMO before IMV is associated with acceptable survival, similar adverse events, and shorter duration of IMV compared to conventional ECMO. This strategy may be preferable in carefully selected patients.

Evidence of sample selectivity in highway injury-severity models: The case of risky driving during COVID-19

Research in highway safety continues to struggle to address two potentially important issues;the role that unobserved factors may play on resulting crash and injury-severity likelihoods, and the issue of identification in safety modeling caused by the self-selective sampling inherent in commonly used safety data (the fact that drivers in observed crashes are not a random sample of the driving population, with riskier drivers being over-represented in crash data bases). This paper addresses unobserved heterogeneity using mixing distributions and attempts to provide insight into the potential sample-selection problem by considering data before and during the COVID-19 pandemic. Based on a survey of vehicle usage (vehicle miles traveled) and subsequent statistical modeling, there is evidence that riskier drivers likely made up a larger proportion of vehicle miles traveled during the pandemic than before, suggesting that the increase in injury severities observed during COVID-19 could potentially be due to the over-representation of riskier drivers in observed crash data. However, by exploring Florida crash data before and during the pandemic (and focusing on crashes where risky behaviors were observed), the empirical analysis of observed crash data suggests (using random parameters multinomial logit models of driver-injury severities with heterogeneity in means and variances) that the observed increase in injury severity during the COVID-19 pandemic (calendar year 2020) was likely due largely to fundamental changes in driver behavior and less to changes in the sample selectivity of observed crash data. The findings of this paper provide some initial guidance to future work that can begin to more rigorously explore and assess the role of selectivity and resulting identification issues that may be present when using observed crash data.

Between paradigms: Comparing patient and parent experiences of injured adolescents treated at pediatric or adult trauma centres

Background: Injured adolescents may go to pediatric (PTC) or adult (ATC) trauma centres. Although there appears to be little difference in mortality when adolescents are managed in PTCs versus ATCs, evidence suggests differences in clinical processes (e.g., computed tomographic scanning, operative intervention). Moreover, there is little information on nonclinical outcome variation. We aimed to examine differences in nonclinical outcomes of injured adolescents admitted to the lead PTC or ATC within a regional Canadian trauma system. Method(s): After injury-related hospital admission at the PTC or ATC, adolescents (15-17 yr, inclusive) and parents completed the following: the Quality of Trauma Acute Care Patient-Reported (or Parent- Reported) Experience Measure (QTAC-PREM), examining clinical care, information delivery, education and social supports, and opioid exposure;the Pediatric Quality of Life Inventory;and the Brief Symptom Inventory, a psychological distress measure. Data were collected on clinical outcomes and processes. Descriptive bivariate analyses compared outcomes by trauma centre type. Result(s): Twenty-six ATC and 32 PTC patients have been enrolled to date. Survey response rates were 69% (patients) and 75% (parents) at the PTC and 58% (patients) and 54% (parents) at the ATC. There was a similar age and sex distribution between the 2 centres. Injury severity was higher at the ATC, reflected by greater mean lengths of stay (PTC 2.3 d [standard deviation (SD) 2.1 d], ATC 13.3 d [SD 23.7 d]), and lower mean Glasgow Coma Scale scores (PTC 15.0, ATC 13.8) at the ATC. There were also 3 critical care admissions at the ATC and none at the PTC among recruited patients. No differences were observed in patient- or parent-reported clinical care and follow-up experiences. There was also no difference in patient- or parent-reported social and educational support, although subscales were limited by visitor restrictions because of the COVID-19 pandemic, and the majority of injuries occurring during summer months when students were out of school. Parents at the ATC reported fewer opportunities to stay with or near their child compared with those at the PTC (100% v. 69.2%). Parents reported better information provision at the PTC (mean 17.3 [SD 1.3] v. 13.9 [SD 5.2], out of 18 as measured by the QTAC-PREM). Patients and parents were more likely to report receiving opioid prescriptions on discharge at the ATC (55.6% v. 14.3%). There was no difference in quality of life or psychological distress between the PTC and ATC. Conclusion(s): Injured adolescents and their parents indicated similar clinical and follow-up experiences, although parents felt better informed at the PTC and reported better opportunities to stay near their child. Parents and patients reported higher opioid exposures at the ATC. Sharing of communication, accommodation and opioid prescribing practices may allow for improved experiences and reduced opioid exposures in injured adolescents presenting to ATCs. Multivariable analyses are necessary in the future to adjust for injury severity differences..

The Impact of the COVID-19 Pandemic on Pediatric Non-accidental Trauma

Background: Non-accidental trauma (NAT) is a global health issue and is responsible for 50,000 deaths worldwide and 1,800 deaths in the United States annually. Established risk factors for NAT include lower socioeconomic status and ethnic minority status. Memphis, TN has the nation's second poorest metropolitan area, with greater than one-third of children living in poverty and a disproportionate number of those being ethnic minority children. The COVID-19 Pandemic, in addition to direct health effects, has brought with it increased financial and social hardship, possibly exacerbating the factors leading to violence against children. We sought to explore what impact the COVID19 Pandemic had on the incidence of NAT within an already atrisk population. Methods: Retrospective registry data was obtained for patients with suspected and confirmed NAT admitted through the Pediatric Emergency Department at our Level 1 Pediatric Trauma Center from 2011-2020. We compared the NAT rates before and during the COVID-19 Pandemic, designated as year 2020, using risk ratios and Chi-squared test. We conducted interrupted time series analysis to examine the impact of COVID-19 and time on the rate of NAT. A P-value ≤ 0.05 was considered statistically significant. Results: The year 2020 showed an increase risk of NAT compared to prior years since 2011, both individually and as a whole. Interrupted time series analysis revealed a steady rise in NAT admissions over the last decade, but this rise was eight-fold above expected rates in the time of the COVID-19 Pandemic, RR 8.64 (95% CI: 3.3-13.9;p 0.006). There was decrease in emergency department encounters by 35.5% during the COVID-19 Pandemic compared to the average over the prior nine years. Patient demographics of NAT admissions prior to the COVID-19 pandemic and during the Pandemic did not significantly change. Injury Severity Score showed a decrease during the pandemic compared to the decade prior to the pandemic (p 0.002). Total hospital days were unaffected but total ICU days showed a decrease from 5.7 to 1.5 days (p <0.001). Conclusion: Our study found a disproportionate increase in incidence of hospitalized NAT cases despite overall decreased volume of emergency department encounters during the COVID-19 Pandemic. Additionally, there was a decrease in injury severity and ICU length of stay, suggesting the increase in hospitalized NAT cases did not result in more critical injury, but rather increased frequency of mild-to-moderate severity of injury. We hypothesize the added social stress and financial impact of the COVID-19 Pandemic has resulted in heightened external stress on families, therefore increasing the risk of NAT in the pediatric population. Further evaluation on a national level, including non-hospitalized children, will need to be conducted. Our study supports the need for increased community awareness of NAT for at-risk children during times of social disruption and financial crisis.

Patterns and mechanisms of major trauma injuries during and after the UK Covid-19 Nationwide lockdown: analysis from a UK Major Trauma Centre.

PURPOSE: To compare patterns and mechanisms of injuries during and after the UK Nationwide lockdown during the COVID-19 pandemic. METHODS: This prospective cohort study included all major trauma admissions during the 10-week period of the nationwide lockdown (09/03/2020-18/05/2020), compared with admissions in the 10-weeks following the full lifting of lockdown restrictions (04/07/20-12/09/2020). Differences in the volume, spectrum and mechanism of injuries presenting during and post-lockdown were compared using Fisher's exact and Chi-squared tests as appropriate. The associated risk of 30-day mortality was examined using univariable and multivariable logistic regression. RESULTS: A total of 692 major trauma admissions were included in this analysis. Of these, 237 patients were admitted during the lockdown and 455 patients were admitted post-lockdown. This represented a twofold increase in trauma admission between the two periods. Characteristically, both cohorts had a higher proportion of male patients (73.84% male during lockdown and 72.5% male post-lockdown). There was a noted shift in age groups between both cohorts with an overall more elderly population during lockdown (p = 0.0292), There was a significant difference in mechanisms of injury between the two cohorts. The 3-commonest mechanisms during the lockdown period were: Road traffic accidents (RTA)-31.22%, Falls of less than 2 m-26.58%, and falls greater than 2 m causing 22.78% of major trauma admissions. However, in the post-lockdown period RTAs represented 46.15% of all trauma admissions with falls greater than 2 m causing 17.80% and falls less than 2 m causing 15.16% of major trauma injuries. With falls in the elderly associated with an increased risk of mortality. In terms of absolute numbers, there was a twofold increase in major trauma injuries due to stabbings and shootings, rising from 25 admitted patients during the lockdown to 53 admitted patients post-lockdown. CONCLUSIONS: The lifting of lockdown restrictions resulted in a twofold increase in major trauma admissions that was also associated with significant changes in both the demographic and patterns of injuries with RTA's contributing almost half of all injury presentations. TRIAL REGISTRATION: This study was classed as a service evaluation and registered with the local audit department, registration number: 20-177C.

Employment and Accommodation Needs in Individuals with Traumatic Brain Injury: A Pilot Study

Introduction: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Sex and gender influence employment in TBI. A large facilitator to employment in TBI is having workplace accommodation, however in many cases accommodations are unavailable or may not fit the needs of the individual. Further, it is unknown how the Coronavirus Disease 2019 (COVID-19) pandemic is impacting employment and accommodations for persons with TBI. This study aims to investigate sex and gender-specific workplace accommodations in persons with TBI, while considering the impact of COVID-19 on transitioning to work and on mental health in adults with TBI. Methods: The proposed research is a pilot study with an observational cross-sectional design. Sixty adults with TBI, including men, women and gender diverse people within the age range of 18-65 years inclusive, will be recruited. An online survey will be self-administered through Research Electronic Data Capture. The survey includes questions on demographics (e.g., sex, gender, age, ethnicity, injury severity, mechanism of injury);questions from the Canadian Survey on Disability 2017 on employment status, requirements and unmet needs for workplace accommodations;and questions from Statistics Canada on the impact of COVID-19 on work status. Results: Data collection is in progress. Planned analyses include multinomial logistic and multivariable linear regression analyses to evaluate the relationships between the predictor (i.e., sex, gender) and main outcome variables (i.e., the number and type of accommodations needed, change in employment status and mental health due to COVID-19). Descriptive statistics, between-group comparisons for sex and gender, and sexspecific and gender-specific stratification will be completed to understand emerging trends. Conclusion: Sex and gender influences in TBI can serve to inform rehabilitation professionals, employers and persons with TBI, to enable sex- and gender-sensitive interventions for community participation practices. Findings from this study will contribute to the body of evidence on sex- and gender-specific workplace accommodations, while bridging the knowledge gap of how to improve transition to work in persons with TBI. Results will also further the understanding of the specific needs of men, women and gender-diverse persons with a disability during community participation postdischarge, including during unprecedented times.

LoveYourBrain Mindset: Feasibility, Usability, and Acceptability of an Online Yoga, Mindfulness, and Psychoeducation Intervention for Traumatic Brain Injury

Objective: Despite the rapid growth of virtual health services in response to COVID-19, people affected by traumatic brain injury (TBI) experience symptoms that can undermine their ability to access and benefit from such services. This study assessed the feasibility, usability, and acceptability of LoveYourBrain Mindset, a manualized, 6-week yoga, mindfulness, and psychoeducation program delivered online to people with TBI and caregivers. To enhance accessibility, participants choose between two interactive tracks, either a weekly 75-min gentle yoga class or a 45-min group discussion on Zoom. Participants also receive weekly pre-recorded tools by email (1-min psychoeducational videos, 45-min yoga classes, 10-min meditations, 25-min yoga nidra meditations). Methods: LoveYourBrain Foundation recruited prospective participants from October 2020-March 2021 through clinical, advocacy, and social media outreach. People were eligible if they were a TBI survivor or caregiver, age 15 to 70, able to participate in gentle exercise and/or group discussion, and consented for their data to be used for research. Self-reported survey data were collected electronically in eligibility and feedback forms. We assessed feasibility by describing the number of people enrolled, number of programs successfully offered, and mean attendance;usability by examining use of the tools;and acceptability by analyzing satisfaction measures. Results: A total of 62 programs were offered by LoveYourBraintrained Facilitators during the study period. No programs were canceled from low enrollment. Eight hundred and nine eligible people enrolled, including 733 people with TBI and 76 caregivers. Participants were majority white (n = 654, 80.8%), non- Hispanic (n = 690, 85.3%), female (n = 640, 79.1%), educated (college graduate/equivalent or higher) (n = 657, 81.2%), and had a median age of 43 years (range 18-80 years). TBI severity ranged from mild (n = 272, 38.1%), moderate (n = 247, 34.6%), to severe (n = 195, 27.3%). Participants were located mostly in 47 states in the US (n = 601, 74.1%) or 8 Canadian provinces (n = 192, 23.7%). A majority (n = 584, 72.2%) attended ≥1 interactive classes, while 26.8% were 'no-shows' (n = 217) and 1.0% withdrew (n = 8). Mean attendance in the interactive classes was 7 (SD 1) people per program. Most participants (n = 263, 74.0%) completed some tools in 5 or all 6 weeks of their program, most often the videos (n = 256, 72.1%), meditations (n = 142, 40.0%), yoga classes (n = 133, 37.5%), and yoga nidras (n = 105, 29.6%). Participants reported high satisfaction (M = 9.1 out of 10, SD 1.4) and a majority (n = 308, 86.7%) would 'Definitely, yes' recommend it to a friend or family. Conclusion: High attendance, engagement, and satisfaction with LoveYourBrain Mindset suggests that online delivery of yoga, mindfulness, and psychoeducation is feasible and acceptable for people with TBI and caregivers. The program's scalability has implications on expanding access to holistic health services for this marginalized community, yet greater efforts are needed to reach minority groups with disproportionately worse access to care, particularly Black, Indigenous and People of Color.

The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center

INTRODUCTION: The COVID-19 pandemic forced the implementation of social distancing guidelines to minimize spread of the coronavirus. However, it is not yet understood what effects these precautions had on the rates of penetrating neurotrauma. METHODS: We retrospectively analyzed neurotrauma data from our institutional trauma registry from distinct periods defined as pre-COVID-19 (March 2019-September 2019) and COVID-19 (March 2020-September 2020). Demographics, injury characteristics, mechanisms of trauma, and past medical history (including psychiatric diagnosis) were collected. Data were analyzed for between-group differences and presented as odds ratios. RESULTS: We observed a significant rise in the number of neurotrauma cases in 2020 (558 vs. 630, OR 1.129 [1.0071, 1.2657]). There was a decrease in the proportion of male victims (71.3% vs. 68.6%, p = 0.03). There were significant differences noted in the mechanism of injury between groups. Patients in 2020 were less likely to present with falls (42.3% vs. 34.3%, OR 0.7119 [0.5627, 0.9005]) and more likely to present with GSW (4.48% vs. 7.78%, OR 1.7981 [1.0951, 2.9523]). Of the patients with penetrating cranial injuries, the most common motive was assault (56.7% vs. 60.0%), followed by self-inflicted (13.3% vs. 20.0%) and accidental (20.0% vs. 18.3%) with a significant difference between years (p = 0.0043). The presence of comorbid psychiatric illness or substance abuse did not confer an increased odds of presenting with penetrating injuries. No significant differences were noted in mean arrival or discharge GCS or injury severity as measured by ISS. However we did observe significant increases in patients presenting with bilaterally reactive pupils (48.3% vs 59.3%, p = 0.0025), patients discharged home (27.6% vs 37.3%, p = 0.0002), and survival at 6 months (41.4% vs. 54.2%, p = 0.0188). CONCLUSION: We observed a higher rate of penetrating neurotrauma while social distancing measures were in place. It is unclear if the psychosocial effects of quarantine and social distancing had a causative relationship with the increased rates of assault and self-inflicted penetrating injuries.

The impact of the UK national lockdown on trauma patterns and the pre-hospital advanced trauma team response within metropolitan London

Introduction: The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within metropolitan London and the impact lockdown had on London’s Air Ambulance’s (LAA) response to incidents. Methods: This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the first UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results: LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] vs. 54.25 [4.53], p < 0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (DV) (0.7% vs. 3.8%) and deliberate self-harm (DSH) (16.5% vs. 12.4%), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion: The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in DV frequency.

A Better Way to Manage Paediatric Maxillofacial Trauma;A Retrospective Study Examining the Presentation of Maxillofacial Soft Tissue Injuries and Management over 3-year period at a Regional Children's Hospital

Introduction: Maxillofacial treatment is evolving with changing paediatric lifestyles and clinical limitations, including COVID-19. The aim of this study is to assess trends in the presentation of maxillofacial soft tissue injuries and subsequent management within a regional paediatric hospital. Methods: Retrospective study over a 3-year period (from 2019-2021 between January and April). Inclusion of all paediatric patients seen on the emergency department by OMFS team. Results: Between 2019 and 2021, the total number of patients dropped by over half. The average age dropped from 5.9 in 2019 to 3.8 in 2021. Males were more commonly seen. Extraoral injuries increased by 21%. Intraoral injuries reduced by 8%. Less complicated communicating injuries and associated dental trauma were seen in 2021. Lip lacerations accounted for most injuries. In 2020, there was 21% reduction in conservative management of injuries. Wound closure under LA increased by 12% in 2020. There has been an overall increase in wound closure under GA by 5% between 2019 and 2020. Falls accounted for most injuries, however, there has been an increase in dog bite injuries by 5% in 2021. Conclusions: The average age has dropped between 2019-2021 and hence treatment options remain limited. Age, cooperation, and severity of injury are important factors. The number of overall lacerations has decreased but a greater proportion required formal closure under general anaesthesia. It is vital OMFS surgeons are aware of the changes in presentation and current trends in management. This will help to better equip surgical teams for the changing landscape of paediatric maxillofacial trauma.

Incidence and Risk of Sports Injuries in Registered Athletes in Mazandaran Province;Reports of the Years Before and After COVID-19 Pandemic

Background and purpose: World condition has changed since the Coronavirus disease 2019 (COVID-19) emerged and its rapid spread affected people’s social and sports life. In this study, we aimed at investigating the incidence of sports injuries in Mazandaran province, Iran and the effects of COVID-19 pandemic on frequency of sports injuries. We also studied the relationship between sports injuries and age, gender, sports specialties and severity of injury. Materials and Methods: In this descriptive-analytical study, information of all/injured athletes registered in Mazandaran Sport Medicine Center between 2018 and 2020 were analyzed in SPSS V23. In order to investigate the relationship between injured limb and age, gender, sports specialty, injured side, and surgery, Chi-square test was applied. Results: The numbers of registered athletes were 51.56, 50.59 and 16.45 per 10,000 population in the province and injured athletes included 6.90, 6.62, and 5.73 per 10,000 registered ones in 2018-2020, respectively. The majority of athletes were men. After the COVID-19 pandemic, the rate of injury was high in soccer (9.09 per 10,000 registered athletes), knee injuries increased to 40.8%, and surgery was performed in 23.3% of all injuries. Significant relationship was found between injured limb and age (P˂0.05) and sport specialty (P˂0.001) during the years studied. Conclusion: Reduction in number of registered athletes and no considerable change in sports injuries indicate a decrease in recreational athletes after the outbreak of the COVID-19 pandemic. However, prohibition of indoor sports activities can be the reason for increase in men injuries, especially football players. Also, professional athletes experienced serious and more knee injuries.

The impact of Covid-19 on severe traumatic brain injury: Neurotrauma code black activations in a UK major trauma centre

Objectives: The mainstay of care in severe traumatic brain injury (TBI) includes time-critical delivery of effective medical and surgical interventions. This is streamlined by Code Black trauma calls at our Major Trauma Centre (MTC). The Covid- 19 pandemic placed unprecedented strain on resources within healthcare and the wider society. The aim of this study was to analyse its effects on the presentation and management of time-critical TBI. Design: Retrospective analysis of the prospective database. Subjects: Patients with severe TBI who triggered Code Black trauma calls from January 2019 until December 2020. Code Black is activated by Glasgow Coma Scale (GCS) ≤ 8, severe mechanism of injury, and changes in pupillary reactivity. Methods: Demographics, clinical, radiological, and surgical findings were collected from medical records and the Trauma and Audit Research Network (TARN);socioeconomic data from the Office for National Statistics. We compared 2019 to the pandemic in 2020. Results: There were 58 and 62 Code Black activations, respectively in 2019 and 2020. During the pandemic, more patients were male (83.9 vs. 65.5%, p = 0.02), and more injuries alcohol-related (33.9 vs. 19.0%) and intentional (19.4 vs. 8.6%). The hospital stay was shorter (21 vs. 32 d). The index of multiple deprivations (IMD) was one decile lower in 2020 (p = 0.036). The mechanism, severity, intracranial findings, timeliness of care, and mortality remained unchanged. Surgical intervention was performed in two-thirds of patients and was associated with higher survival (68.0%) vs. non-surgical treatment (40.0%, p = 0.003). Predictors of in-hospital mortality included increasing age, injury severity, and pupillary changes. Conclusions: The Covid-19 pandemic brought a change to the pattern of time-critical TBI and disproportionately affected lower socioeconomic groups. Although the volume of work remained unchanged, we maintained high-quality care throughout. This highlights the need to retain trauma services during the Covid-19 pandemic.

Experience from a level-1 major trauma centre in England of trauma epidemiology after easing of lockdown restrictions

Aim: The COVID-19 pandemic transformed trauma care. We examined the effect of lockdown easing on trauma presentation and management. Method: Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to one Major Trauma Centre in the East of England with trauma. The first 47 days of lockdown (23rd March-9th May 2020, period 1) were compared with the next (10th May- 26th June 2020, period 2) and last 47 (27th June- 13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management, and length of stay. Results: 1,249 patients were included;62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs 143) but rebounded by May (123 v 120 patients). Road traffic collisions increased over periods 1-3 (18.8% v 23% v 30.1%, p=0.038);deliberate self-harm (DSH) increased in period 2 compared with 1 and 3 (6.3% v 3.4% v 1.4%, p=0.03) respectively. The 2020 patient age was younger than 2019, with less trauma relating to alcohol (7.3% v 13.2%, p=0.009). Compared with 2019 reductions in total length of stay (14.1 v 17.4 days, p=<0.001), critical care length of stay (2.3 v 2.9 days, p=0.04) and consultant driven care (54.9% v 64.9%, p<0.001) were noted in lockdown. Conclusions: Our study suggests that after lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.