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1.
Surg Infect (Larchmt) ; 22(9): 948-954, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1522102

ABSTRACT

Background: In trauma, direct pulmonary injury and innate immune response activation primes the lungs for acute respiratory distress syndrome (ARDS). The inflammasome-dependent release of interleukin-18 (IL-18) was recently identified as a key mediator in ARDS pathogenesis, leading us to hypothesize that plasma IL-18 is a diagnostic predictor of ARDS in severe blunt trauma. Patients and Methods: Secondary analysis of the Inflammation and Host Response to Injury database was performed on plasma cytokines collected within 12 hours of severe blunt trauma. Trauma-related cytokines, including IL-18, were compared between patients with and without ARDS and were evaluated for association with ARDS using regression analysis. Threshold cytokine concentrations predictive of ARDS were determined using receiver-operating curve (ROC) analysis. Results: Cytokine analysis of patients without ARDS patients (n = 61) compared with patients with ARDS (n = 19) demonstrated elevated plasma IL-18 concentration in ARDS and IL-18 remained correlated with ARDS on logistic regression after confounder adjustment (p = 0.008). Additionally, ROC analysis revealed IL-18 as a strong ARDS predictor (area under the curve [AUC] = 0.83), with a threshold IL-18 value of 170 pg/mL (Youden index, 0.3). Unlike in patients without ARDS, elevated IL-18 persisted in patients with ARDS during the acute injury phase (p ≤ 0.02). Other trauma-related cytokines did not correlate with ARDS. Conclusions: In severe blunt trauma, IL-18 is a robust predictor of ARDS and remains elevated throughout the acute injury phase. These findings support the use of IL-18 as a key ARDS biomarker, promoting early identification of trauma patients at greater risk of developing ARDS. Timely recognition of ARDS and implementation of advantageous supportive care practices may reduce trauma-related ARDS morbidity and costs.


Subject(s)
Respiratory Distress Syndrome , Wounds, Nonpenetrating , Humans , Interleukin-18 , Logistic Models , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Risk Assessment , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnosis
2.
Trauma Surg Acute Care Open ; 5(1): e000581, 2020.
Article in English | MEDLINE | ID: covidwho-1476824

ABSTRACT

BACKGROUND: Whole blood viscoelastic testing (VET) devices are routinely used in a variety of clinical settings to assess hemostasis. The Quantra QStat System is a cartridge-based point of care VET device that measures changes in clot stiffness during coagulation and fibrinolysis using ultrasound detection of resonance. The objective of this study was to assess the ability of the Quantra QStat System to detect coagulopathies in trauma patients. METHODS: A multicenter observational study was conducted on adult subjects at two level 1 trauma centers. For each subject, whole blood samples were drawn upon arrival to the emergency department and again, in some cases, after administration of blood products and/or antifibrinolytics. Samples were analyzed on the Quantra in parallel to ROTEM delta. The QStat cartridge provides measures of Clot Time (CT), Clot Stiffness (CS), Fibrinogen and Platelet Contributions to clot stiffness (FCS and PCS), and Clot Stability to Lysis (CSL). Data analyses included linear regression of Quantra and ROTEM parameters and an assessment of the concordance of the two devices for the assessment of hyperfibrinolysis. RESULTS: A total of 56 patients were analyzed. 42% of samples had a low QStat CS value suggestive of an hypocoagulable state. The low stiffness values could be attributed to either low PCS, FCS or combination. Additionally, 13% of samples showed evidence of hyperfibrinolysis based on the QStat CSL parameter. Samples analyzed with ROTEM assays showed a lower prevalence of low CS and hyperfibrinolysis based on EXTEM and FIBTEM results. The correlation of CS, FCS and CT versus equivalent ROTEM parameters was strong with r-values of 0.83, 0.79 and 0.79, respectively. DISCUSSION: This first clinical experience with the Quantra in trauma patients showed that the QStat Cartridge was strongly correlated with ROTEM parameters and that it could detect coagulopathies associated with critical bleeding. LEVEL OF EVIDENCE: Diagnostic test, Level II.

4.
Int J Environ Res Public Health ; 18(11)2021 05 28.
Article in English | MEDLINE | ID: covidwho-1256514

ABSTRACT

BACKGROUND: This study examined the effect of the COVID-19 pandemic and the resulting decrease in the incidence of various categories of injuries, with the main focus on fractures and mild traumatic brain injuries in a paediatric population. METHODS: This retrospective cohort study evaluated all children from 0 to 18 years of age presenting with an injury at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery in Vienna during the lockdown from 16 March to 29 May 2020 compared to records over the same timeframe from 2015 to 2019. RESULTS: In total, 14,707 patients with injuries were included. The lockdown did not lead to a significant decrease in fractures but, instead, yielded a highly significant increase in mild traumatic brain injuries when compared to all injuries that occurred (p = 0.082 and p = 0.0001) as well as acute injuries (excluding contusions, distortions and miscellaneous non-acute injuries) (p = 0.309 and p = 0.034). CONCLUSIONS: The percentage of paediatric fractures did not decrease at the level 1 trauma centre, and a highly significant proportional increase in paediatric patients with mild traumatic brain injuries was observed during the COVID-19 lockdown. Therefore, medical resources should be maintained to treat paediatric trauma patients and provide neurological monitoring during pandemic lockdowns.


Subject(s)
COVID-19 , Trauma Centers , Wounds and Injuries , Child , Communicable Disease Control , Europe , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
5.
Clin Imaging ; 77: 250-253, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1245894

ABSTRACT

OBJECTIVE: Amidst COVID-19 pandemic, many states have issued stay at home advisories and non-essential business closures to limit public exposure. During this "quarantine" period, it is important to understand the volume and types of emergency/trauma radiology cases to better prepare for the continuing and future pandemics. This study demonstrates new trends in pathologies and an overall increase in positive exams. METHODS: A retrospective review of emergency department's imaging during the initial two weeks of this state's quarantine period, 3/23/2020-4/5/2020 was compared to similar dates of the previous year ("pre-quarantine" period), 3/25/2019-4/7/2019. One thousand emergency radiology and 991 trauma cases were evaluated. Of the emergency radiology cases 500 studies from each period were assessed, and from the trauma cases, 783 cases from pre-quarantine and 315 from the quarantine period were examined. Chi-square analysis was performed to assess for statistical significance. RESULTS: Overall there were 43.0% fewer emergency radiology studies performed during the quarantine period (n = 4530) compared to pre-quarantine period (n = 2585). Additionally, the number of positive cases was significantly higher (P = 0.0001) during the quarantine period (43.0%) compared to the pre-quarantine period (30.2%). Several trends in types of trauma were observed, including a significant increase in domestic violence during the quarantine period (P = 0.0081). DISCUSSION: Different volumes and types of emergency/trauma imaging cases were observed during the recent quarantine period. Findings may assist emergency radiology departments to plan for future pandemics or COVID-19 resurgences by offering evidence of the types and volume of emergency radiology cases one might expect.


Subject(s)
COVID-19 , Radiology , Emergency Service, Hospital , Humans , Pandemics , Quarantine , Retrospective Studies , SARS-CoV-2
6.
Eur J Trauma Emerg Surg ; 47(5): 1335-1342, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1241588

ABSTRACT

PURPOSE: There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients. METHODS: A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups. RESULTS: A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients. CONCLUSION: This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.


Subject(s)
COVID-19 , Humans , Injury Severity Score , Intensive Care Units , Length of Stay , Retrospective Studies , SARS-CoV-2 , Trauma Centers
7.
Cureus ; 13(4): e14444, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1231583

ABSTRACT

Introduction The coronavirus disease 2019 (COVID-19) virus was declared a pandemic on March 10, 2020 by the World Health Organization (WHO) and has massively burdened healthcare systems with cases exponentially rising throughout the United States and the rest of the world. Since implementing precautions to reduce the spread of this disease, emergency departments have seen a decrease in the number of traumas. By evaluating the differences in the number of trauma admissions in different subgroups of patients, we can assess where to target messaging to increase compliance with these precautions. In this study, we aim to analyze the effect of the COVID-19 pandemic on trauma admissions. Methodology This was a retrospective review of the trauma database at our institution, a level 2 trauma center in Southern California, to assess the impact of COVID-19 on the number of traumas. The inclusion criteria were patients activated as traumas, regardless of age. Patients were excluded from the study if they did not have complete information in the trauma database. Data were stratified by date into two groups: (a) COVID period (January to April 2020) and (b) pre-COVID period (January to April 2019). The primary endpoint of this study was to determine whether there was a significant change in the number of patients presenting as trauma during the COVID-19 pandemic. This difference was analyzed and divided into subgroups based on age and trauma type. Results In our review, an average of 279 patients per month presented as trauma from January to April in 2019, and an average of 222 patients per month presented as trauma from January to April 2020 (p = 0.049). We found a significant decrease in the number of patients presenting with the chief complaint of fall and vehicular accident, but a nonsignificant difference in patients presenting as assaults or pedestrian accidents. There was also a significant decrease in the number of traumas in the 18-39 and 65+ age groups and a nonsignificant decrease in the 40-64 age group. It was also noted that the number of trauma admissions in May 2020 increased to 253 compared to 269 in 2019. This increase was most notable in the 18-39 and 40-64 age groups. Discussion As seen in the data, the most notable year-over-year difference was seen in March and April. In California specifically, a stay-at-home order was set in place in March, which was in conjunction with the WHO's declaration of a pandemic. An interesting finding was the significant decrease in patients with traumas in the age groups of 18-39 and 65+ from 2019 to 2020. There was a smaller, nonsignificant decrease in patients aged 40-64. This would be a good group to target with future messaging to increase compliance with health advisories. There was also a notable increase in the number of traumas in May 2020, signaling an end to the cooperation of the majority of people, also indicating that further measures needed to be enacted in all groups. Conclusions COVID-19 has disrupted social structures worldwide. As the pandemic continued, even the observers of stay-at-home and social distancing measures, the 18-39 age group, became fatigued with the guidelines and ventured out into the warming weather and summer activities. This difference in trauma admission due to COVID-19 between subsequent years can highlight the behavioral changes in our patient population and can be further extrapolated to target additional messaging to help reduce the spread of COVID-19.

8.
Am J Orthopsychiatry ; 91(2): 171-180, 2021.
Article in English | MEDLINE | ID: covidwho-1226414

ABSTRACT

Evidence from multiple samples of trauma-exposed populations across the globe suggests that intergenerational trauma constitutes a biopsychological risk factor which manifests itself throughout the life cycle of offspring of trauma survivors. Prior empirical studies have shown that adult children of Holocaust survivors (OHS, also referred to in select quotes as 2G for "Second Generation") are vulnerable to life-threatening situations. This study aimed to examine the reactions of OHS to the COVID-19 pandemic, which posed a serious threat to the lives of many, in particular to older adults. As they enter middle age, OHS were observed to have more medical health issues and less positive perceptions of their own aging relative to peers. Less positive subjective aging was associated with more negative psychiatric symptoms in relation to Covid-19-related loneliness, further suggesting that OHS are a group of aging adults with particular vulnerabilities to negative mental health effects of the pandemic and of the social distancing and isolation it imposed. This study is a qualitative report of experiences expressed by over 1,200 participants in several web-based interactive webinars for OHS during the period of "shelter at home" in March and April 2020. It is proposed that this format of "web-based, second-best" way of being together, an intervention that emerged spontaneously in response to the coronavirus and social distancing, offers a novel, nonpathologizing, effective form of supportive psychosocial intervention uniquely suited to the unprecedented challenges experienced during times requiring social distancing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Holocaust/psychology , Psychotherapy, Group/methods , Survivors/psychology , Adult Children/psychology , Anxiety/etiology , Anxiety/therapy , COVID-19/therapy , Humans , Internet , Siblings/psychology
9.
Soc Sci Med ; 278: 113956, 2021 06.
Article in English | MEDLINE | ID: covidwho-1201965

ABSTRACT

RATIONALE: It has been recognized that exposure to mass trauma tends to increase the time spent watching television (TV) news. Yet, research on the effects of this tendency on individuals' well-being yielded inconclusive findings. OBJECTIVE: The aim of this longitudinal study is to examine the effects of prior trauma and posttraumatic stress disorder (PTSD) on changes in the amount of TV news watching and its effect on subsequent PTSD. More specifically, we examined the interrelations of prior exposure to war captivity, long-term PTSD trajectories, and amount of change TV news watching with PTSD severity during the COVID-19 pandemic, among aging Israeli combat veterans. METHODS: One-hundred-and-twenty Israeli ex-prisoners of war (ex-POWs) from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) were followed up at five points of time: 1991 (T1), 2003 (T2), 2008 (T3), 2015 (T4), and in April-May 2020 (T5), during the outbreak of the COVID-19 pandemic. RESULTS: Ex-POWs had higher odds of COVID-19 related increase in TV news watching, which, in turn, contributed to PTSD severity at T5. In addition, delayed PTSD trajectory was associated with COVID-19 related increase in TV news watching, which, in turn, contributed to more severe PTSD at T5. CONCLUSIONS: These findings highlight the negative implications of TV news watching during a mass trauma for traumatized individuals. More specifically, they demonstrate its potential pathogenic role in exacerbating prior PTSD among trauma survivors.


Subject(s)
COVID-19 , Prisoners of War , Stress Disorders, Post-Traumatic , Veterans , Humans , Israel/epidemiology , Longitudinal Studies , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology
11.
Int J Mol Sci ; 22(8)2021 Apr 15.
Article in English | MEDLINE | ID: covidwho-1196033

ABSTRACT

Amyloidoses are a group of diseases associated with the formation of pathological protein fibrils with cross-ß structures. Approximately 5-10% of the cases of these diseases are determined by amyloidogenic mutations, as well as by transmission of infectious amyloids (prions) between organisms. The most common group of so-called sporadic amyloidoses is associated with abnormal aggregation of wild-type proteins. Some sporadic amyloidoses are known to be induced only against the background of certain pathologies, but in some cases the cause of amyloidosis is unclear. It is assumed that these diseases often occur by accident. Here we present facts and hypotheses about the association of sporadic amyloidoses with vascular pathologies, trauma, oxidative stress, cancer, metabolic diseases, chronic infections and COVID-19. Generalization of current data shows that all sporadic amyloidoses can be regarded as a secondary event occurring against the background of diseases provoking a cellular stress response. Various factors causing the stress response provoke protein overproduction, a local increase in the concentration or modifications, which contributes to amyloidogenesis. Progress in the treatment of vascular, metabolic and infectious diseases, as well as cancers, should lead to a significant reduction in the risk of sporadic amyloidoses.


Subject(s)
Amyloidosis/etiology , Stress, Physiological , Brain Injuries/complications , Communicable Diseases/complications , Humans , Metabolic Diseases/complications , Neoplasms/complications , Oxidative Stress , Vascular Diseases/complications
12.
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
13.
J Clin Orthop Trauma ; 18: 44-50, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1188728

ABSTRACT

AIMS: To evaluate the safety and transmission of COVID-19 in trauma patients during the coronavirus pandemic at a time of rapid reorganization of hospital health services. METHODS: All patients sustaining trauma requiring surgery treated in our institution during the lockdown period were included. Retrospective data for all admissions were collected, including outcomes, length of stay and complications. Telephone interviews were performed with all patients, families or their carers to assess COVID-19 transmission at minimum of 6 week post-discharge. RESULTS: 161 patients underwent surgery, 107 females and 54 males with average age of 56 (2-99). There were lower limb related procedures, upper limb related respectively. 13 people died during this period, of these one was directly attributed to COVID-19 related morbidity. 75% responded to telephone interviews and found no cases of symptomatic spread to any patient or household members. CONCLUSION: Following reorganization, our experience has shown that trauma services can be safely resumed with little to no significant adverse effect to patient or spread into community, especially as concerns of second wave risk overwhelming the NHS. We advocate that rigorous testing of COVID pre-operatively and with development of local COVID-19 standard operating protocols will also reduce and prevent the spread of COVID-19.

14.
Trauma Surg Acute Care Open ; 6(1): e000655, 2021.
Article in English | MEDLINE | ID: covidwho-1183383

ABSTRACT

BACKGROUND: The COVID-19 pandemic resulted in nationwide social distancing and shelter-in-place orders meant to curb transmission of the SARS-CoV-2 virus. The effect of the pandemic on injury patterns has not been well described in the USA. The study objective is to determine the effect of the COVID-19 pandemic on the distribution and determinants of traumatic injuries. METHODS: This retrospective multi-institutional cohort study included all hospital admissions for acute traumatic injury at six community level I trauma centers. Descriptive statistics were used to compare injury causes, diagnoses and procedures over two similar time periods: prepandemic (March 11-June 30, 2019) and pandemic (March 11-June 30, 2020). RESULTS: There were 7308 trauma patients included: 3862 (53%) prepandemic and 3446 (47%) during the pandemic. Cause of injury significantly differed by period (p<0.001). During the pandemic, there were decreases in motor vehicle crashes (from 17.0% to 14.0%, p<0.001), worksite injuries (from 5.2% to 4.1%, p=0.02), pedestrian injuries (from 3.0% to 2.2%, p=0.02) and recreational injuries (from 3.0% to 1.7%, p<0.001), while there were significant increases in assaults (6.9% to 8.5%, p=0.01), bicycle crashes (2.8% to 4.2%, p=0.001) and off-road vehicle injuries (1.8% to 3.0%, p<0.001). There was no change by study period in falls, motorcycle injuries, crush/strikes, firearm and self-inflicted injuries, and injuries associated with home-improvement projects. Injury diagnoses differed between time periods; during the pandemic, there were more injury diagnoses to the head (23.0% to 27.3%, p<0.001) and the knee/leg (11.7% to 14.9%, p<0.001). There were also increases in medical/surgical procedures (57.5% to 61.9%, p<0.001), administration of therapeutics/blood products (31.4% to 34.2%, p=0.01) and monitoring (11.0% to 12.9%, p=0.01). DISCUSSION: Causes of traumatic injury, diagnoses, and procedures were significantly changed by the pandemic. Trauma centers must adjust to meet the changing demands associated with altered injury patterns, as they were associated with increased use of hospital resources. LEVEL OF EVIDENCE: III (epidemiological).

15.
Trauma Surg Acute Care Open ; 6(1): e000640, 2021.
Article in English | MEDLINE | ID: covidwho-1183382

ABSTRACT

BACKGROUND: Increased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type. METHODS: This was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods. RESULTS: A total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01). DISCUSSION: This study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic. LEVEL OF EVIDENCE: Retrospective, level III study.

16.
Cureus ; 13(3): e13871, 2021 Mar 13.
Article in English | MEDLINE | ID: covidwho-1168107

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, our aim was to protect staff and patients, therefore, face-to-face clinics were converted to telephone clinics. We retrospectively compared two groups of patients: those seen in traditional clinics pre-COVID-19 and those who had telephone clinics during the pandemic. The mean Ashford Clinic Letter Score (ACLS) for the face-to-face clinic letters was 6.7, and the letters from both groups of telemedicine appointments scored better; the first group scoring 7.1 and the second 7.45. The pandemic allowed us to show that telephone clinics are effective and can be superior to traditional clinics in a specific set of patients.

17.
Diabetes Metab Syndr ; 15(3): 667-671, 2021.
Article in English | MEDLINE | ID: covidwho-1157244

ABSTRACT

BACKGROUND AND AIMS: Ever since COVID-19 was declared a pandemic by WHO in late March 2020, more and more people began to share their opinions online about the anxiety, stress, and trauma they suffered because of the pandemic. However, very few studies were conducted to analyze the general public's perception of what causes stress, anxiety, and trauma during COVID-19. This study focuses particularly on understanding Indian citizens. METHODS: By using Machine learning techniques, particularly Natural language processing, this study focuses on understanding the attitude of Indian citizens while discussing the anxiety, stress, and trauma created because of COVID-19 and the major reasons that cause it. We used Tweets as data for this study. We have used 840,000 tweets for this study. RESULTS: Our sentiment analysis study revealed the interesting fact that, even while discussing about the stress, anxiety, and trauma caused by COVID-19, most of the tweets were in neutral sentiments. Death and Lockdown caused by the COVID-19 were the two most important aspects that cause stress, anxiety, and Trauma among Indian citizens. CONCLUSION: It is important for policymakers and health professionals to understand common citizen's perspectives of what causes them stress, anxiety, and trauma to formulate policies and treat the patients. Our study shows that Indian citizens use social media to share their opinions about COVID-19 and as a coping mechanism in unprecedented time.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Perception , Anxiety/epidemiology , Anxiety/psychology , Attitude to Death , Attitude to Health , COVID-19/mortality , Communicable Disease Control , Data Analysis , Humans , India/epidemiology , Machine Learning , Mental Health/statistics & numerical data , Pandemics , Physical Distancing , Public Opinion , Quarantine/psychology , Quarantine/statistics & numerical data , SARS-CoV-2 , Social Media/statistics & numerical data , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Trauma and Stressor Related Disorders/epidemiology , Trauma and Stressor Related Disorders/psychology
18.
Bone Jt Open ; 2(3): 211-215, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1146882

ABSTRACT

AIMS: Virtual fracture clinics (VFCs) are advocated by recent British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs) to efficiently manage injuries during the COVID-19 pandemic. The primary aim of this national study is to assess the impact of these standards on patient satisfaction and clinical outcome amid the pandemic. The secondary aims are to determine the impact of the pandemic on the demographic details of injuries presenting to the VFC, and to compare outcomes and satisfaction when the BOAST guidelines were first introduced with a subsequent period when local practice would be familiar with these guidelines. METHODS: This is a national cross-sectional cohort study comprising centres with VFC services across the UK. All consecutive adult patients assessed in VFC in a two-week period pre-lockdown (6 May 2019 to 19 May 2019) and in the same two-week period at the peak of the first lockdown (4 May 2020 to 17 May 2020), and a randomly selected sample during the 'second wave' (October 2020) will be eligible for the study. Data comprising local VFC practice, patient and injury characteristics, unplanned re-attendances, and complications will be collected by local investigators for all time periods. A telephone questionnaire will be used to determine patient satisfaction and patient-reported outcomes for patients who were discharged following VFC assessment without face-to-face consultation. ETHICS AND DISSEMINATION: The study results will identify changes in case-mix and numbers of patients managed through VFCs and whether this is safe and associated with patient satisfaction. These data will provide key information for future expert-led consensus on management of trauma injuries through the VFC. The protocol will be disseminated through conferences and peer-reviewed publication. This protocol has been reviewed by the South East Scotland Research Ethics Service and is classified as a multicentre audit. Cite this article: Bone Jt Open 2021;2(3):211-215.

19.
J Trauma Acute Care Surg ; 90(4): 714-721, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1145211

ABSTRACT

BACKGROUND: The COVID-19 pandemic resulted in a statewide stay-at-home (SAH) order in California beginning March 19, 2020, forcing large-scale behavioral changes and taking an emotional and economic toll. The effects of SAH orders on the trauma population remain unknown. We hypothesized an increase in rates of penetrating trauma, gunshot wounds, suicide attempts, and domestic violence in the Southern California trauma population after the SAH order. METHODS: A multicenter retrospective analysis of all trauma patients presenting to 11 American College of Surgeons levels I and II trauma centers spanning seven counties in California was performed. Demographic data, injury characteristics, clinical data, and outcomes were collected. Patients were divided into three groups based on injury date: before SAH from January 1, 2020, to March 18, 2020 (PRE), after SAH from March 19, 2020, to June 30, 2020 (POST), and a historical control from March 19, 2019, to June 30, 2019 (CONTROL). POST was compared with both PRE and CONTROL in two separate analyses. RESULTS: Across all periods, 20,448 trauma patients were identified (CONTROL, 7,707; PRE, 6,022; POST, 6,719). POST had a significantly increased rate of penetrating trauma (13.0% vs. 10.3%, p < 0.001 and 13.0% vs. 9.9%, p < 0.001) and gunshot wounds (4.5% vs. 2.4%, p = 0.002 and 4.5% vs. 3.7%, p = 0.025) compared with PRE and CONTROL, respectively. POST had a suicide attempt rate of 1.9% and a domestic violence rate of 0.7%, which were similar to PRE (p = 0.478, p = 0.514) and CONTROL (p = 0.160, p = 0.618). CONCLUSION: This multicenter Southern California study demonstrated an increased rate of penetrating trauma and gunshot wounds after the COVID-19 SAH orders but no difference in attempted suicide or domestic violence rates. These findings may provide useful information regarding resource utilization and a target for societal intervention during the current or future pandemic(s). LEVEL OF EVIDENCE: Epidemiological, level IV.


Subject(s)
COVID-19 , Domestic Violence/statistics & numerical data , Physical Distancing , Suicide, Attempted/statistics & numerical data , Wounds, Gunshot/epidemiology , Wounds, Penetrating/epidemiology , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , California/epidemiology , Female , Historically Controlled Study , Humans , Male , Retrospective Studies , SARS-CoV-2
20.
BMJ Open ; 11(3): e046405, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1138357

ABSTRACT

OBJECTIVES: COVID-19 has changed the epidemiology of trauma. However, Taiwan is a country with a low COVID-19 threat, and people's daily lives have remained mostly unchanged during this period. The purpose of this study is to investigate whether the trend of trauma incidence and the service of trauma care is affected by the relatively minor COVID-19 pandemic in Taiwan. DESIGN: A single-institute, retrograde cohort study. SETTING: An observational study based on the trauma registry of Chang Gung Memorial Hospital (CGMH). PARTICIPANTS: Trauma patients presented to the emergency department of CGMH in the period of 1 January to 30 June 2020 (week 1 to week 26) were designated as the COVID-19 group, with 1980 patients in total. Patients of the same period in 2015-2019 were designated as the pre-COVID-19 group, with 10 334 patients overall. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the incidence of trauma admission. Differences in trauma mechanism, severity, location and outcome were also compared in both groups. RESULTS: A decrease in trauma incidence during March and April 2020 was noticed. Significant change (p<0.001) in trauma mechanisms was discovered, with decreased burn (5.8% vs 3.6%) and assault (4.8% vs 1.2%), and increased transport accidents (43.2% vs 47.2%) and suicide (0.2% vs 1.0%) in the COVID-19 cohort. A shift in injury locations was also found with a 5% decrement of workplace injuries (19.8% vs 14.8%, p<0.001). CONCLUSION: The limited COVID-19 outbreak in Taiwan has led to a decreased incidence of trauma patients, and the reduction is mostly attributed to the decline in workplace injuries.


Subject(s)
COVID-19 , Emergency Service, Hospital/trends , Pandemics , Wounds and Injuries/epidemiology , Humans , Retrospective Studies , Taiwan/epidemiology
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