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1.
Pragmat Obs Res ; 13:93-103, 2022.
Article in English | PubMed | ID: covidwho-2022219

ABSTRACT

BACKGROUND: The COVID-19 pandemic globally impacted trauma facilities and overall healthcare utilization. This study was conducted to characterize the utilization of trauma services at our Level I Trauma Center in New York City during the COVID-19 pandemic compared to the preceding pre-pandemic year. METHODS: A retrospective study of patient presenting to our Level 1 Trauma Center in Staten Island, New York. The pre-pandemic data was extracted from March 1st, 2019-February 29th, 2020. The pandemic year was divided into two phases: the initial wave (March 1st-Sept 1st, 2020) and the protracted phase (September 1st, 2020-March 1st, 2021). Patients were identified using ICD-10 coding and data regarding patient factors, mechanism of injury, and service utilization was extracted from the medical record. Statistical analysis was performed using IBM SPSS v.24. RESULTS: A total of 1650 trauma activations registered during the pre-pandemic phase, 691 during the initial wave, and 826 during the protracted phase. Compared to pre-pandemic, the number of Level 1 trauma activations remained unchanged, however mechanisms of injury shifted. Gunshot wounds (2.6% vs 1.2%), motorcycle crash (4.2% vs 2.0%) and blunt force injury caused by an object (strike injuries) (2.7% vs 1.3%) significantly increased during the initial wave (p-value <0.05). There was a significant decrease in the percentage of both female (2.93% vs 2.33% vs 5.64%, p-value <0.01) and pediatric (3.30% vs 3.64% vs 12.9%, p-value <0.001) assault activations during the initial wave and protracted phase when compared to pre-pandemic levels, respectively. No significant changes were observed for self-harm, falls, accidents, burns, sports injuries, stab wounds, autobody collisions, or motor vehicle accident activations. CONCLUSION: Trauma centers should be prepared for increases in violent trauma. We also emphasize the need to implement strategies to raise public awareness of pediatric and female assault in the domestic setting, particularly during a mandatory stay-at-home policy where underreporting may occur.

2.
J Orthop Surg Res ; 17(1): 306, 2022 Jun 11.
Article in English | MEDLINE | ID: covidwho-1886952

ABSTRACT

INTRODUCTION: Due to the global COVID-19 pandemic, a ban on sports outside one's home and a prohibition on travel between communities were imposed in spring 2020 in Tyrol, Austria. The aim of this study was to evaluate the impact of these restrictions on a level one trauma center. The objective was to identify the most common injury patterns to ensure targeted prevention in times of an ongoing pandemic. MATERIAL AND METHODS: Patients who presented themselves to our trauma center between weeks 7 and 22 in 2020 were retrospectively compared to a mean of the patients of the three previous years (2017-2019). The evaluated variables were the number of patients, age, gender, country of residence, place of accident, time of treatment, injured body region and anatomical structure, number of surgical intervention and severely injured patients. RESULTS: Comparing the mean count of treated patients per week in 2020 of the pre-lockdown period (n = 804.6) with the lockdown period (n = 201.8) a decrease in admissions by 69.7% could be observed. The admission incidence was 9.9 times higher in previous years than in 2020 during the lockdown period. Among the injuries treated during the lockdown the largest increase in relative numbers was in home injuries, head or face injuries and superficial or penetrating injuries. There was a decrease of seriously injured patients as well as patients that needed surgery during the lockdown compared to previous years. CONCLUSIONS: We observed a significant change in the pattern and volume of injuries during a strict lockdown. Intervention programs to reduce the risk of home injuries should be introduced. Furthermore, in order to save resources during a pandemic, specific guidelines on patient management and treatment should be established for the respective medical specialties. TRIAL REGISTRATION: 1157/2020, 10.12.2020.


Subject(s)
COVID-19 , COVID-19/epidemiology , Communicable Disease Control , Humans , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2 , Trauma Centers
3.
Acta Anaesthesiol Scand ; 66(2): 265-272, 2022 02.
Article in English | MEDLINE | ID: covidwho-1506929

ABSTRACT

BACKGROUND: The COVID-19 pandemic demanded changes in societal behavior and health care worldwide. Previous studies have compared trauma patient admissions in COVID-19-related lockdowns to prior years. This study describes the COVID-19 impact on trauma patient admissions during entire 2020 at a major trauma center in Denmark. METHODS: We retrospectively analyzed trauma patients received by a trauma team and admitted at Aarhus University Hospital in 2020 compared with 2018-2019. The incidence of injuries, mechanism of injury, 30-day mortality, and Injury Severity Score (ISS) were investigated. RESULTS: The incidence of minor injuries (ISS 1-15) increased by 24% in 2020 compared with 2018-2019 (incidence rate ratio 1.24 [95% CI: 1.11-1.39]). The incidence of severe injuries (ISS >15) in 2020 did not change compared with 2018-2019 (incidence rate ratio 0.97 [95% CI: 0.80-1.17]). The 30-day mortality was similar in 2020 compared with 2018-2019. Comparing 2020 with 2018-2019, the risk ratio of traffic injuries decreased (0.90 [95% CI: 0.82-0.99]), risk ratio for fall injuries was 1.13 (95% CI: 0.97-1.30), for violence 1.13 (95% CI: 0.51-2.50), and for self-harm 1.94 (95% CI: 0.95-3.94). During the first lockdown of 2020, trauma team activations declined from 49.5 to 42 and the risk ratio for traffic injuries was 0.74 (95% CI: 0.50-1.10) compared with the same period in 2018-2019. CONCLUSION: The incidence of minor injuries increased, but the incidence of severe injuries was similar in 2020 compared with 2018-2019. Societal restrictions might alter the mechanism of injuries. The first lockdown indicated an association with reduced traffic injuries.


Subject(s)
COVID-19 , Communicable Disease Control , Denmark/epidemiology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Trauma Centers
4.
Am Surg ; 88(3): 404-408, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1467789

ABSTRACT

INTRODUCTION: There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC). METHODS: We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020. Patients were grouped into a pre-COVID or COVID period. The primary aim of this study was to compare rates of VAW between groups. Secondary aims sought to evaluate for any difference in traumatic mechanism between periods and to determine if a temporal relationship existed between COVID-19 and VAW rates. RESULTS: There was no difference in rates of VAW between the pre-COVID and COVID period (3.1% vs 3.6%, P = .6); however, rates of penetrating trauma were greater during the COVID period (38.2% vs 10.3%, P = .01). After controlling for patient age and race, the odds of penetrating trauma increased during the pandemic (OR 5.8, 95% CI 1.6-28.5, P < .01). From February 2020 through October 2020, there was a direct relationship between rates of COVID-19 and VAW (r2 .78, P < .01). CONCLUSION: Rates of VAW were unchanged between the pre-COVID and COVID periods, yet the odds of penetrating VAW were 5 times greater during the pandemic. Moving forward, trauma surgeons must remain vigilant for signs of violence and ensure that support services are available during future crises.


Subject(s)
COVID-19/epidemiology , Gender-Based Violence/statistics & numerical data , Pandemics , Trauma Centers/statistics & numerical data , Wounds, Nonpenetrating/epidemiology , Wounds, Penetrating/epidemiology , Adult , COVID-19/prevention & control , Female , Gender-Based Violence/ethnology , Humans , Injury Severity Score , Intimate Partner Violence/ethnology , Intimate Partner Violence/statistics & numerical data , Linear Models , Ohio/epidemiology , Retrospective Studies , Wounds, Nonpenetrating/ethnology , Wounds, Penetrating/ethnology , Young Adult
5.
World Neurosurg ; 152: e603-e609, 2021 08.
Article in English | MEDLINE | ID: covidwho-1347858

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic sent shockwaves through health services worldwide. Resources were reallocated. Patients with COVID-19 still required instrumented spinal surgery for emergencies. Clinical outcomes for these patients are not known. The objective of this study was to evaluate the effects of COVID-19 on perioperative morbidity and mortality for patients undergoing emergency instrumented spinal surgery and to determine risk factors for increased morbidity/mortality. METHODS: This retrospective cohort study included 11 patients who were negative for COVID-19 and 8 patients who were positive for COVID-19 who underwent emergency instrumented spinal surgery in 1 hospital in the United Kingdom during the pandemic peak. Data collection was performed through case note review. Patients in both treatment groups were comparable for age, sex, body mass index (BMI), comorbidities, surgical indication, and preoperative neurologic status. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariable analysis was used to identify risk factors for increased morbidity. RESULTS: There were no mortalities in either treatment group. Four patients positive for COVID-19 (50%) developed a complication compared with 6 (55%) in the COVID-19-negative group (P > 0.05). The commonest complication in both groups was respiratory infection. Three patients positive for COVID-19 (37.5%) required intensive care unit admission, compared with 4 (36%) in the COVID-19-negative group (P > 0.05). The average time between surgery and discharge was 19 and 10 days in COVID-19-positive and -negative groups, respectively (P = 0.02). In the COVID-19 positive group, smoking, abnormal BMI, preoperative oxygen requirement, presence of fever, and oxygen saturations <95% correlated with increased risk of complications. CONCLUSIONS: Emergency instrumented spinal surgery in patients positive for COVID-19 was associated with increased length of hospital stay. There was no difference in occurrence of complications or intensive care unit admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.


Subject(s)
COVID-19/complications , Spinal Fusion , Spinal Injuries/surgery , Spinal Injuries/virology , Adult , Aged , COVID-19/mortality , Cohort Studies , Emergency Treatment/adverse effects , Emergency Treatment/methods , Female , Humans , Length of Stay , Male , Middle Aged , Postoperative Complications/epidemiology , Risk Factors , SARS-CoV-2 , Spinal Fusion/adverse effects , Spinal Fusion/mortality , Treatment Outcome , United Kingdom
6.
Eur J Trauma Emerg Surg ; 47(3): 665-675, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1195138

ABSTRACT

PURPOSE: In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. METHODS: All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. RESULTS: During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. CONCLUSION: This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.


Subject(s)
COVID-19 , Infection Control/methods , Surgical Procedures, Operative , Trauma Centers , Wounds and Injuries , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Emergencies/epidemiology , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Germany/epidemiology , Humans , Incidence , Male , Organizational Innovation , Retrospective Studies , SARS-CoV-2 , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data , Trauma Centers/organization & administration , Trauma Centers/statistics & numerical data , Trauma Severity Indices , Wounds and Injuries/diagnosis , Wounds and Injuries/epidemiology , Wounds and Injuries/etiology , Wounds and Injuries/surgery
7.
Eur J Trauma Emerg Surg ; 48(2): 841-846, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1184642

ABSTRACT

PURPOSE: The effects of the first pandemic wave on a German Level I Trauma Center should be evaluated to find ways to redistribute structural, personnel, and financial resources in a targeted manner in preparation for the assumed second pandemic wave. METHODS: We examined the repercussions of the first wave of the pandemic on the trauma surgery clinic of a Level I Trauma Center and compared the data with data from 58 other trauma clinics. The results could aid in orientating the distribution of structural, financial, and human resources (HR) during the second wave. The period between March 16 and April 30, 2020 was compared with the data over the same period during 2019. Information was collected from the HR department, central revenue management, and internal documentation. RESULTS: The proportion of trauma surgical patients in the emergency room decreased by 22%. The number of polytrauma cases increased by 53%. Hospital days of trauma surgery patients in the intensive and intermediate care wards increased by 90%. The number of operations decreased by 15%, although the operating time outside of normal working hours increased by 44%. Clinics with more than 600 beds recorded a decrease in cases and emergencies by 8 and 9%, respectively, while the Trauma Center showed an increase of 19 and 12%. The results reflect the importance of level I trauma centers in the lockdown phase. CONCLUSION: To reduce the risk of an increased burden on the healthcare infrastructure, it suggests the care of trauma and COVID-19 patients should be separated locally, when possible.


Subject(s)
COVID-19 , Trauma Centers , COVID-19/epidemiology , Communicable Disease Control , Humans , Pandemics , SARS-CoV-2
8.
Craniomaxillofac Trauma Reconstr ; 14(4): 277-283, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-992359

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVE: Following SARS-CoV-2 pandemic break-out a lockdown period for the population and a reorganization of the Health System were needed. Hub-function Centers for time-dependent diseases were identified and Niguarda Hospital (Milan) was selected as main Regional Trauma Center. The purpose of our study is to report the experience of Niguarda Maxillofacial Trauma Team during this period, pointing out epidemiological changes in the presentation of trauma in comparison to the previous 3 years. METHODS: Two hundred and sixteen patients were admitted to the Emergency Department from 8th March 2020 to 8th May 2020. One hundred and eighty-one had a diagnosis of Major Trauma and 36 had also facial fractures; 35 patients had isolated facial fractures. Data were compared to the activity during the same period in 2017-2019 and statistical analysis was carried out concerning demographic and clinical characteristics, trauma dynamics and positivity to COVID-19. RESULTS: Cumulative curves of patients admitted because of Major Trauma describe a superimposable linear trend in years 2017-2019, while 2020 shows an increase from April 16th. Average age and number of more severe patients were higher than previous years. Epidemiological changes concerned road accidents, accidents involving pedestrians and cyclists, interpersonal violence, suicide attempts and domestic accidents. The incidence of facial fractures was confirmed through years and, according to its measured severity, 75% of patients required management. COVID-19 positivity without systemic symptoms didn't influence the type of treatment. CONCLUSION: The COVID-19 lockdown offers a unique opportunity to study the reversal epidemiological effects on trauma.

9.
Injury ; 51(11): 2437-2441, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-899013

ABSTRACT

The COVID pandemic of 2020 resulted in unprecedented restrictions of public life in most countries around the world, and many hospital systems experienced dramatic decreases in non-COVID related patient admissions. We aimed to compare trauma volumes, patient characteristics, and trauma mechanisms at a large, urban Level 1 trauma center in the United States during a state-wide "State of Emergency" and "stay-at-home" order to corresponding historic dates. All adult trauma activations from March 1 through April 30, 2020 and a historic control from March 1 through April 30, 2018 and 2019 were reviewed in the institution's trauma registry. Trauma volumes, patient characteristics, and trauma mechanisms were compared over time as increasingly stricter COVID-related restrictions were enacted in the Commonwealth of Virginia. After declaration of a state-wide "Public Health Emergency" on March 17, 2020, the daily number of trauma activations significantly declined to a mean of 4.7 (standard deviation, SD = 2.6), a decrease by 43% from a mean of 8.2 (SD = 0.3) for the same dates in 2018 and 2019. Trauma activations during COVID restrictions vs. historic control were characterized by significantly higher prevalence of chronic alcohol use (15.5% vs. 6.8%, p < 0.01), higher median (25th - 75th percentile) Injury Severity Score of 9 (5 - 16) vs. 6 (4 - 14), p = 0.01, and shorter median (25th - 75th percentile) length of hospital stay of 2 (1 - 6) days vs. 3 (1 - 7) days, p = 0.03. The COVID-related Public Health Emergency and "stay-at-home" order in the Commonwealth of Virginia dramatically reduced overall trauma volumes with minor but interesting changes in trauma patterns.


Subject(s)
COVID-19 , Trauma Centers , Adult , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
10.
HSS J ; 16(Suppl 1): 92-96, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-846102

ABSTRACT

BACKGROUND: The effect of COVID-19 on pediatric trauma rates is still largely under investigation. With the potential need to reallocate human and financial resources at this challenging time, it will be useful to have detailed descriptions of the rates of pediatric trauma and understanding of how the pandemic affects these rates. QUESTIONS/PURPOSES: We sought to describe the effect of the COVID-19 pandemic on the number of acute pediatric trauma admissions and procedures performed in a level-I trauma center in Cork University Hospital, Ireland. METHODS: We compared the number of acute traumatic pediatric admissions and procedures that occurred during the first 4 weeks of a nationwide lockdown due to COVID-19 with that of the same 4-week period in each of the preceding 11 years. Seasonal variables were measured and controlled for using multivariate regression analysis. RESULTS: A total of 545 pediatric patients (under 16 years of age) were included. Over 12 years, the lowest number of acute traumatic pediatric admissions and procedures was recorded during the 2020 pandemic. There was a significant correlation between the number of school days and the number of acute traumatic admissions, as well as the procedures performed. The relationship between the number of school days and the number of trauma procedures was evident even when controlling for confounder variables of seasonal variation. CONCLUSION: The COVID-19 pandemic significantly reduced the number of acute traumatic pediatric admissions and procedures performed in our level-I trauma center, likely because of a reduction in school days. With the reopening of schools, playgrounds, and sporting events, an increase in pediatric trauma admissions is anticipated. The results of this study can help prepare institutions and regulatory bodies to plan appropriately for this new phase.

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