Pre-hospital and Hospital Trauma Care during the Covid-19 Lockdown – Experience in a Metropolitan European Level 1 Trauma Centre

Julian Scherer; Claudio Canal; Ernest Kaufmann; Kai Oliver Jensen; Hans-Christoph Pape; Valentin Neuhaus

doi:10.1055/a-2039-3162

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2024; 162(03): 283-288
DOI: 10.1055/a-2039-3162

Original Article

Pre-hospital and Hospital Trauma Care during the Covid-19 Lockdown – Experience in a Metropolitan European Level 1 Trauma Centre

Präklinische und klinische Traumaversorgung während des COVID-19-Lockdowns - Erfahrungen aus einer europäischen Großstadt in einem Traumazentrum der Stufe 1

Authors

Julian Scherer

¹Department of Traumatology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
Claudio Canal

¹Department of Traumatology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
Ernest Kaufmann

²Department of Urology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
Kai Oliver Jensen

¹Department of Traumatology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
Hans-Christoph Pape

¹Department of Traumatology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)
Valentin Neuhaus

¹Department of Traumatology, University Hospital Zurich, Zurich, Switzerland (Ringgold ID: RIN27243)

Abstract

Background Trauma case load is said to have declined during the Covid-19 pandemic, especially during the national lockdowns. Due to the altered frequency and changes in daily life, pre-hospital care (altered personal protective measurements) as well as mechanisms of trauma and initial trauma treatment may have changed. The purpose of this study was to assess differences in pre-hospital as well as initial treatment of trauma victims and trauma mechanisms during a national lockdown compared to the year before.

Material and Methods Pre-hospital as well as clinical data from all trauma patients admitted to our metropolitan level 1 trauma center resuscitation room during the hard lockdown in Switzerland (March 17 to April 26, 2020) and the same time period in 2019 were analyzed retrospectively.

Results In total, we assessed 91 patients (51 lockdown cohort, 40 control cohort) with a mean age of 50.7 years. Significantly more trauma was sustained in the household environment during the lockdown (p = 0.015). Pre-hospital treatment remained similar between the two assessed groups. No difference was found in length of stay or mortality. In severely injured patients (ISS > 15), we found significantly fewer motor vehicle accidents (p = 0.018) and fewer horizontal decelerations (p = 0.006), but insignificantly more falls (p = 0.092) in the lockdown cohort. None of the patients in the lockdown cohort had a positive PCR test for Covid-19 on admission.

Conclusion Trauma systems seem not to have changed during hard lockdowns in terms of pre-hospital treatment. Fewer severely injured patients due to motor vehicle accidents and horizontal decelerations, but more household-related injuries were seen in the lockdown cohort than in the control cohort. A qualitative analysis of treatment during the hard lockdown is needed to gain further insights into the effect of the pandemic on trauma care.

Zusammenfassung

Hintergrund Es wurde gezeigt, dass die Zahl der Traumafälle während der COVID-19-Pandemie und insbesondere während der landesweiten Lockdowns zurückgegangen war. Aufgrund der veränderten Häufigkeit und Veränderungen des täglichen Lebens könnten sich die präklinische Versorgung (vermehrte protektive Maßnahmen) sowie die Mechanismen der Traumata und die initiale Verletzungsbehandlung verändert haben. Der Zweck dieser Studie war es, Unterschiede in der präklinischen sowie Erstbehandlung von Traumaopfern und Traumamechanismen während des nationalen Lockdowns im Vergleich zum Vorjahr zu bewerten.

Methodik Präklinische sowie klinische Daten aller Traumapatienten, die während des harten Lockdowns in der Schweiz (17. März bis 26. April 2020) und im gleichen Zeitraum im Jahr 2019 in den Schockraum unseres europäischen Level-1-Traumazentrums aufgenommen wurden, wurden retrospektiv analysiert.

Ergebnisse Insgesamt untersuchten wir 91 Patienten (51 in der Lockdown-Kohorte, 40 in der Kontroll-Kohorte) mit einem Durchschnittsalter von 50,7 Jahren. Signifikant mehr Traumata wurden während des Lockdowns im häuslichen Umfeld erlitten (p = 0,015). Die präklinische Behandlung blieb zwischen den beiden untersuchten Gruppen ähnlich. Es wurde kein Unterschied in Bezug auf die Aufenthaltsdauer oder die Sterblichkeit gefunden. Bei Schwerverletzten (ISS > 15) fanden wir signifikant weniger Fahrzeugunfälle (p = 0,018) und weniger horizontale Dezelerationen (p = 0,006), aber unwesentlich mehr Stürze (p = 0,092) in der Lockdown-Kohorte. Keiner der Patienten in der Lockdown-Kohorte hatte bei der Aufnahme einen positiven PCR-Test auf COVID-19.

Fazit Die präklinischen Behandlung von verletzten Patienten scheint sich während des harten Lockdowns nicht verändert zu haben. In der Lockdown-Kohorte gab es weniger Schwerverletzte durch Fahrzeugunfälle und horizontaler Dezelerationen, jedoch mehr Haushaltsunfälle im Vergleich zur Kontroll-Kohorte. Eine qualitative Analyse der präklinischen Behandlung während des harten Lockdowns könnte weitere Einsicht in die Auswirkungen der Pandemie auf die Traumaversorgung geben.

Keywords

trauma - Covid-19 - trauma systems - pre-hospital care

Schlüsselwörter

Trauma - COVID-19 - Traumasystem - präklinische Versorgung

Full Text

References

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