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Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry.
Giudici, Riccardo; Lancioni, Armando; Gay, Hedwige; Bassi, Gabriele; Chiara, Osvaldo; Mare, Claudio; Latronico, Nicola; Pesenti, Antonio; Faccincani, Roberto; Cabrini, Luca; Fumagalli, Roberto; Chieregato, Arturo; Briani, Laura; Sammartano, Fabrizio; Sechi, Giuseppe; Zoli, Alberto; Pagliosa, Andrea; Foti, Giuseppe; Borotto, Erika; Palo, Alessandra; Valoti, Oliviero; Botteri, Marco; Carlucci, Michele; Reitano, Elisa; Bini, Roberto.
  • Giudici R; Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.
  • Lancioni A; Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy.
  • Gay H; Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy.
  • Bassi G; Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.
  • Chiara O; Emergency Department, General Surgery and Trauma Team, ASST Niguarda, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milano, Italy. osvaldo.chiara@unimi.it.
  • Mare C; Regional Agency of Emergency and Urgency, Milan, Italy.
  • Latronico N; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
  • Pesenti A; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
  • Faccincani R; Department of Anesthesia, Critical Care and Emergency, Fondazione Policlinico, University of Milan, Milan, Italy.
  • Cabrini L; Emergency Department, Ospedale San Raffaele, Milan, Italy.
  • Fumagalli R; Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
  • Chieregato A; Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.
  • Briani L; Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Milan, Italy.
  • Sammartano F; Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, Milan, Italy.
  • Sechi G; Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy.
  • Zoli A; Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, Milan, Italy.
  • Pagliosa A; Regional Agency of Emergency and Urgency, Milan, Italy.
  • Foti G; Regional Agency of Emergency and Urgency, Milan, Italy.
  • Borotto E; Regional Agency of Emergency and Urgency, Milan, Italy.
  • Palo A; Department of Anesthesia and Intensive Care Medicine, S.Gerardo Hospital, University Milano Bicocca, Monza, Italy.
  • Valoti O; Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
  • Botteri M; Regional Agency of Emergency and Urgency, Pavia, Italy.
  • Carlucci M; Regional Agency of Emergency and Urgency, Bergamo, Italy.
  • Reitano E; Regional Agency of Emergency and Urgency, Brescia, Italy.
  • Bini R; General and Emergency Surgery and Emergency Department, Ospedale San Raffaele, Milan, Italy.
World J Emerg Surg ; 16(1): 39, 2021 07 19.
Article in English | MEDLINE | ID: covidwho-1318287
ABSTRACT
BACKGROUNDS The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods.

METHODS:

A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography.

RESULTS:

During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001).

CONCLUSIONS:

The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Trauma Centers / Wounds and Injuries / Registries / Delivery of Health Care / Pandemics / COVID-19 / Intensive Care Units Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: World J Emerg Surg Year: 2021 Document Type: Article Affiliation country: S13017-021-00383-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Trauma Centers / Wounds and Injuries / Registries / Delivery of Health Care / Pandemics / COVID-19 / Intensive Care Units Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: World J Emerg Surg Year: 2021 Document Type: Article Affiliation country: S13017-021-00383-y