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

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

Publication History

Received: 25 May 2022

Accepted after revision: 17 February 2023

Article published online:
04 April 2023

• References

• 1 Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg 2020; 107: 785-787 DOI: 10.1002/bjs.11627. (PMID: 32191340)
• 2 Perrin N, Iglesias JF, Rey F. et al. Impact of the COVID-19 pandemic on acute coronary syndromes. Swiss Med Wkly 2020; 150: w20448 DOI: 10.4414/smw.2020.20448. (PMID: 33382905)
• 3 Earp BE, Zhang D, Benavent KA. et al. The Early Effect of COVID-19 Restrictions on an Academic Orthopedic Surgery Department. Orthopedics 2020; 43: 228-232 DOI: 10.3928/01477447-20200624-03. (PMID: 32674173)
• 4 Leichtle SW, Rodas EB, Procter L. et al. The influence of a statewide “Stay-at-Home” order on trauma volume and patterns at a level 1 trauma center in the United States. Injury 2020; 51: 2437-2441 DOI: 10.1016/j.injury.2020.08.014. (PMID: 35641328)
• 5 Popp D, Worlicek M, Koch M. et al. Analyse des Trauma-Aufkommens in einer unfallchirurgischen Universitätsklinik während der SARS-CoV‑2-Pandemie. Unfallchirurg 2021; 124: 343-351 DOI: 10.1007/s00113-021-00985-w. (PMID: 33624183)
• 6 Teuben MPJ, Pfeifer R, Teuber H. et al. Lessons learned from the mechanisms of posttraumatic inflammation extrapolated to the inflammatory response in COVID-19: a review. Patient Saf Surg 2020; 14: 28 DOI: 10.1186/s13037-020-00253-7. (PMID: 32665786)
• 7 Coimbra R, Edwards S, Kurihara H. et al. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur J Trauma Emerg Surg 2020; 46: 505-510 DOI: 10.1007/s00068-020-01364-7. (PMID: 32303798)
• 8 Garcia-Castrillo L, Petrino R, Leach R. et al. European Society For Emergency Medicine position paper on emergency medical systems’ response to COVID-19. Eur J Emerg Med 2020; 27: 174-177 DOI: 10.1097/MEJ.0000000000000701. (PMID: 32243317)
• 9 Halvachizadeh S, Teuben M, Berk T. et al. The impact of SARS-CoV-2 (COVID-19) pandemic on trauma bay management and guideline adherence in a European level-one-trauma centre. Int Orthop 2020; 44: 1621-1627 DOI: 10.1007/s00264-020-04740-5. (PMID: 32719932)
• 10 Jarvis S, Salottolo K, Berg GM. et al. Examining emergency medical services’ prehospital transport times for trauma patients during COVID-19. Am J Emerg Med 2021; 44: 33-37 DOI: 10.1016/j.ajem.2021.01.091. (PMID: 33578329)
• 11 Olding J, Zisman S, Olding C. et al. Penetrating trauma during a global pandemic: Changing patterns in interpersonal violence, self-harm and domestic violence in the Covid-19 outbreak. Surgeon 2021; 19: e9-e13 DOI: 10.1016/j.surge.2020.07.004. (PMID: 32826157)
• 12 Kreis CA, Ortmann B, Freistuehler M. et al. Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center. Eur J Trauma Emerg Surg 2021; 47: 665-675 DOI: 10.1007/s00068-021-01654-8. (PMID: 33881555)
• 13 Copes WS, Champion HR, Sacco WJ. et al. The Injury Severity Score revisited. J Trauma 1988; 28: 69-77 DOI: 10.1097/00005373-198801000-00010. (PMID: 3123707)
• 14 Loftis KL, Price J, Gillich PJ. Evolution of the Abbreviated Injury Scale: 1990–2015. Traffic Inj Prev 2018; 19 (Suppl. 02) S109-S113 DOI: 10.1080/15389588.2018.1512747. (PMID: 30543458)
• 15 Tschaikowsky T, Becker von Rose A, Consalvo S. et al. [Numbers of emergency room patients during the COVID-19 pandemic]. Notf Rett Med 2021; 24: 943-952 DOI: 10.1007/s10049-020-00757-w. (PMID: 32837303)
• 16 Fuchs KF, Eden L, Gilbert F. et al. Führt eine COVID-19-bedingte Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten an einem überregionalen Traumazentrum?. Unfallchirurg 2021; 124: 352-357 DOI: 10.1007/s00113-020-00924-1. (PMID: 33252703)
• 17 Pinggera D, Klein B, Thomé C. et al. The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown. Eur J Trauma Emerg Surg 2021; 47: 653-658 DOI: 10.1007/s00068-020-01445-7. (PMID: 32699916)
• 18 Tanne JH. Covid-19: New York City deaths pass 1000 as Trump tells Americans to distance for 30 days. BMJ 2020; 369: m1333 DOI: 10.1136/bmj.m1333. (PMID: 32238356)
• 19 World Health Organization (WHO). Events as they happen. Rolling updates on coronavirus disease (COVID-19). 31.07.2020 Accessed February 24, 2023 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
• 20 Kim JU, Majid A, Judge R. et al. Effect of COVID-19 lockdown on alcohol consumption in patients with pre-existing alcohol use disorder. Lancet Gastroenterol Hepatol 2020; 5: 886-887 DOI: 10.1016/S2468-1253(20)30251-X. (PMID: 32763197)
• 21 Clay JM, Parker MO. Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?. Lancet Public Health 2020; 5: e259 DOI: 10.1016/S2468-2667(20)30088-8. (PMID: 32277874)
• 22 Niedzwiedz CL, Green MJ, Benzeval M. et al. Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study. J Epidemiol Community Health 2021; 75: 224-231 DOI: 10.1136/jech-2020-215060. (PMID: 32978210)
• 23 Hall AJ, Clement ND, MacLullich AMJ. et al. IMPACT-Scot 2 report on COVID-19 in hip fracture patients. Bone Joint J 2021; 103-B: 888-897 DOI: 10.1302/0301-620X.103B.BJJ-2020-2027.R1. (PMID: 33487012)
• 24 Zahoor U, Malik C, Raja H. et al. Effect of COVID-19 on Orthopaedic Trauma Admissions and Operating in a London District General Hospital. Surg J (N Y) 2022; 8: e283-e289 DOI: 10.1055/s-0042-1757883. (PMID: 36225886)
• 25 Biegon A. Considering Biological Sex in Traumatic Brain Injury. Front Neurol 2021; 12: 576366 DOI: 10.3389/fneur.2021.576366. (PMID: 33643182)