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Karmali S, Saxena S, Richards O, Thompson W, McFaull SR, Pike I. What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury. Front Public Health 2024; 12:1385452. [PMID: 38887259 PMCID: PMC11180821 DOI: 10.3389/fpubh.2024.1385452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. Objective A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Methods Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. Results The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Implications Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.
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Affiliation(s)
- Shazya Karmali
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | | | | | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Murphy S, Zwane K, Williams K, Omar S. The effect of the SARS-CoV2 pandemic and lockdown on non-Covid ICU admissions: Experience from a South African tertiary hospital. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2024; 40:e1435. [PMID: 38989476 PMCID: PMC11232567 DOI: 10.7196/sajcc.2024.v40i1.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 07/12/2024] Open
Abstract
Background Future pandemic planning involves analysing past experiences. We compared intensive care unit (ICU) admissions during the SARS-CoV-2 pandemic (2020) with the preceding year. Objectives To assess the SARS-CoV-2 pandemic's effect on ICU admissions in a tertiary hospital, examining differences in patient characteristics, organ support requirements, reason for admission, mortality rates and length of ICU stay. Methods This retrospective cohort study compared ICU patient data at a tertiary hospital during the SARS-CoV-2 pandemic (26 March 2020 to 20 September 2020) with the same period in 2019. Results Patient admissions (p=0.39) and severity of illness (p=0.27 adults; p=0.92 paediatrics) showed no differences across the study period. Similarly, no differences were observed for underlying chronic conditions between the two years. Adult trauma admissions significantly declined, specifically those related to road traffic accidents (RR 0.63). Admissions for acute infectious conditions, including respiratory infections, sepsis, urosepsis, septic arthritis and gastroenteritis significantly declined in both adults (RR 0.50) and paediatric admissions (RR 0.25). During the lockdown period, the length of stay (LOS) decreased for adults, but mortality rates remained unchanged across the study period. The paediatric mortality rate decreased during the lockdown period (p=0.004). Conclusion There was no reduction in SARS-CoV-2-negative ICU admissions during the 2020 lockdown period compared with the preceding year, likely due to chronic resource limitations. We found a decrease in acute trauma and acute infectious illness admissions, while acute surgical emergency admissions increased. These findings suggest that lockdown orders may have affected admission patterns, aiding in future pandemic planning. Contribution of the study The study highlights the chronic shortage of critical care resources in South Africa and aids with future pandemic preparedness and planning in a resource limited setting.
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Affiliation(s)
- S Murphy
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - K Zwane
- Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - K Williams
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - S Omar
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Critical Care Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Cho SH, Nho WY, Lee DE, Ahn JY, Kim JW, Lim KH, Ryoo HW, Kim JK. Impact of COVID-19 pandemic on interhospital transfer of patients with major trauma in Korea: a retrospective cohort study. BMC Emerg Med 2024; 24:53. [PMID: 38570762 PMCID: PMC10988904 DOI: 10.1186/s12873-024-00963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Interhospital transfer (IHT) is necessary for providing ultimate care in the current emergency care system, particularly for patients with severe trauma. However, studies on IHT during the pandemic were limited. Furthermore, evidence on the effects of the coronavirus disease 2019 (COVID-19) pandemic on IHT among patients with major trauma was lacking. METHOD This retrospective cohort study was conducted in an urban trauma center (TC) of a tertiary academic affiliated hospital in Daegu, Korea. The COVID-19 period was defined as from February 1, 2020 to January 31, 2021, whereas the pre-COVID-19 period was defined as the same duration of preceding span. Clinical data collected in each period were compared. We hypothesized that the COVID-19 pandemic negatively impacted IHT. RESULTS A total of 2,100 individual patients were included for analysis. During the pandemic, the total number of IHTs decreased from 1,317 to 783 (- 40.5%). Patients were younger (median age, 63 [45-77] vs. 61[44-74] years, p = 0.038), and occupational injury was significantly higher during the pandemic (11.6% vs. 15.7%, p = 0.025). The trauma team activation (TTA) ratio was higher during the pandemic both on major trauma (57.3% vs. 69.6%, p = 0.006) and the total patient cohort (22.2% vs. 30.5%, p < 0.001). In the COVID-19 period, duration from incidence to the TC was longer (218 [158-480] vs. 263[180-674] minutes, p = 0.021), and secondary transfer was lower (2.5% vs. 0.0%, p = 0.025). CONCLUSION We observed that the total number of IHTs to the TC was reduced during the COVID-19 pandemic. Overall, TTA was more frequent, particularly among patients with major trauma. Patients with severe injury experienced longer duration from incident to the TC and lesser secondary transfer from the TC during the COVID-19 pandemic.
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Affiliation(s)
- Sung Hoon Cho
- Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Woo Young Nho
- Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Dong Eun Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Yun Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Joon-Woo Kim
- Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyoung Hoon Lim
- Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Mukit M, McCandless MG, Davidson JC, Hopper S, Jabbour JI, Davidson SF, Walker M. The Evolution of Hand Injuries at a State's Only Level I Trauma Center: A Look From the 1980s Through the Global Pandemic. Cureus 2024; 16:e54882. [PMID: 38533158 PMCID: PMC10965227 DOI: 10.7759/cureus.54882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The purpose of this study is to evaluate any changes to hand trauma in the past three decades and through the COVID-19 pandemic. We hypothesized that improved consumer safety regulations, changes in access to care, and the impact of a global pandemic, among other variables, have significantly influenced the mechanisms and treatment of hand injuries between the 1980s, 2010s (pre-COVID-19), and 2020s (post-COVID-19). METHODS A retrospective single-center review was performed at the only level I trauma center in Mississippi, identifying all hand trauma consultations between 2012-2019 and 2020-2021, compared to aggregated data from 1989. RESULTS Car accidents, gunshots, saw injuries, door injuries, and falls increased in 2012-2019 and 2020-2021 compared to 1989, whereas knife injuries, glass injuries, industrial injuries, and burns decreased. Crush injuries, de-gloving injuries, and lacerations with irregular edges were increased in recent cohorts, corresponding with increased amputations and tissue loss. Skin and subcutaneous injuries decreased in modern cohorts, corresponding with a decreased ability for primary skin repair and the need for more flaps. Additionally, while hospitalizations have increased, patients have improved follow-up. CONCLUSIONS The nature of hand trauma has changed significantly over the past three decades. Increased numbers of cars and greater access to firearms might have led to increased rates of high-energy trauma, whereas burn and industrial injuries have decreased, potentially secondary to improved safety efforts. Despite increased overall hand trauma, time to treatment and follow-up have improved. Through this study, we can be more cognizant of the evolution of hand trauma in the modern era. This can allow improved access to care and further refine management to optimize functionality for hand injuries.
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Affiliation(s)
- Muntazim Mukit
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | | | - John C Davidson
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Samuel Hopper
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Jacob I Jabbour
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | | | - Marc Walker
- Surgery, University of Mississippi Medical Center, Jackson, USA
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Flury T, Gerber J, Anwander H, Müller M, Jakob DA, Exadaktylos A, Klingberg K. Who was at risk of trauma-related injuries during the COVID-19 pandemic? A retrospective study from a level 1 trauma centre in Switzerland. Swiss Med Wkly 2024; 154:3539. [PMID: 38579330 DOI: 10.57187/s.3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION During the first wave of the COVID-19 pandemic, increasingly strict restrictions were imposed on the activities of the Swiss population, with a peak from 21 March to 27 April 2020. Changes in trauma patterns during the pandemic and the lockdown have been described in various studies around the world, and highlight some particularly exposed groups of people. The objective of this study was to assess changes in trauma-related presentations to the emergency department (ED) during the first wave of the COVID-19 pandemic, as compared to the same period in the previous year, with a particular focus on vulnerable populations. MATERIALS AND METHODS All trauma-related admissions to our ED in the first half of 2019 and 2020 were included. Patient demographics, trauma mechanism, affected body region, injury severity and discharge type were extracted from our hospital information system. Trauma subpopulations, such as interpersonal violence, self-inflicted trauma, geriatric trauma and sports-related trauma were analysed. RESULTS A total of 5839 ED presentations were included in our study, of which 39.9% were female. Median age was 40 years (interquartile range: 27-60). In comparison to 2019, there was a 15.5% decrease in trauma-related ED presentations in the first half of 2020. This decrease was particularly marked in the 2-month March/April period, with a drop of 36.8%. In 2020, there was a reduction in injuries caused by falls of less than 3 metres or by mechanical force. There was a marked decrease in sports-related trauma and an increase in injuries related to pedal cycles. Geriatric trauma, self-harm and assault-related injuries remained stable. CONCLUSION This study described changes in trauma patterns and highlighted populations at risk of trauma during the pandemic in Switzerland in the context of previous international studies.These results may contribute to resource management in a future pandemic.
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Affiliation(s)
- Till Flury
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Gerber
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karsten Klingberg
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Flesher N, Zayat MN, Ablah E, Okut H, Lightwine K, Haan JM. Characteristics of Attempted and Completed Suicides During the COVID-19 Pandemic. Am Surg 2023; 89:5795-5800. [PMID: 37164366 PMCID: PMC10183328 DOI: 10.1177/00031348231173968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND This study aimed to describe patients admitted for attempted or completed suicide during the COVID-19 pandemic. METHODS A 1-year retrospective review was performed of adult patients admitted for attempted or completed suicide. RESULTS Of the 30 patients included, most injuries involved firearms (37%) and cutting/piercing (30%). Sixty-three percent of patients presented with an Injury Severity Score ≥16, and 37% of injuries involved the head. Upon admission, an alcohol test was completed for 83% of patients, 56% of whom tested positive. Thirty percent of patients died from their injuries, with all but one involving a firearm. Most of those who survived to discharge (62%) were discharged to an inpatient behavioral health facility. DISCUSSION The current study indicated a large proportion of suicides during the COVID-19 pandemic involved firearms and alcohol use. These findings point to the need for interventions aimed at preventing suicide and substance abuse during pandemic situations.
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Affiliation(s)
- Nathan Flesher
- Department of Population Health, The University of Kansas School of
Medicine Wichita, Wichita, KS, USA
| | - Marisa-Nicole Zayat
- Department of Population Health, The University of Kansas School of
Medicine Wichita, Wichita, KS, USA
| | - Elizabeth Ablah
- Department of Population Health, The University of Kansas School of
Medicine Wichita, Wichita, KS, USA
| | - Hayrettin Okut
- Department of Population Health, The University of Kansas School of
Medicine Wichita, Wichita, KS, USA
| | - Kelly Lightwine
- Departments of Trauma Services, Ascension Via Christi Hospital Saint
Francis, Wichita, KS, USA
| | - James M. Haan
- Department of Population Health, The University of Kansas School of
Medicine Wichita, Wichita, KS, USA
- Departments of Trauma Services, Ascension Via Christi Hospital Saint
Francis, Wichita, KS, USA
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Sung J, Choi J, Whang K, Cho SM, Kim J, Lee SJ, Jang YG. Comparison of Clinical Characteristics of Traumatic Brain Injury Patients According to the Mechanism Before and After COVID-19. Korean J Neurotrauma 2023; 19:307-313. [PMID: 37840608 PMCID: PMC10567520 DOI: 10.13004/kjnt.2023.19.e44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 10/17/2023] Open
Abstract
Objective This study investigated the change in the number of patients with head trauma according to the trauma mechanism among severely injured patients transferred to the emergency department of Wonju Severance Christian Hospital before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods Medical records (sex, age, diagnosis, trauma mechanism, and injury severity score) of patients referred to the emergency room between January 2018 and December 2019 and January 2020 and December 2021 were retrospectively reviewed, verified, and compared. Results Between 2020 and 2021, the number of patients with traumatic brain injury decreased by 251 (32%). No significant differences were observed in sex, age, or time of accident. From 2020 to 2021, among the trauma mechanisms, the number of cases involving rolling down slightly reduced compared with those involving other mechanisms. Furthermore, cerebral contusions among intracranial lesions significantly increased during the COVID-19 pandemic. Conclusion Partial restrictions on social activities owing to COVID-19 are ongoing. Further investigation of the clinical characteristics of trauma patients over a longer period is required.
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Affiliation(s)
- Jonghyun Sung
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Jongwook Choi
- Department of Neurosurgery, Kunkuk University Chungju Hospital, Chungju, Korea
| | - Kum Whang
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Min Cho
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jongyeon Kim
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yeon gyu Jang
- Department of Neurosurgery, Kunkuk University Chungju Hospital, Chungju, Korea
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Jojczuk M, Pawlikowski J, Kamiński P, Głuchowski D, Naylor K, Gajewski J, Karpiński R, Krakowski P, Jonak J, Nogalski A, Czerwiński D. Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness. Healthcare (Basel) 2023; 11:2436. [PMID: 37685470 PMCID: PMC10486767 DOI: 10.3390/healthcare11172436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.
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Affiliation(s)
- Mariusz Jojczuk
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Jakub Pawlikowski
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Piotr Kamiński
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Dariusz Głuchowski
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, University of Technology, 20-618 Lublin, Poland; (D.G.)
| | - Katarzyna Naylor
- Independent Unit of Emergency Medical Services and Specialist Emergency, Medical University of Lublin, Chodzki 7, 20-093 Lublin, Poland
| | - Jakub Gajewski
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-439 Lublin, Poland
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Dariusz Czerwiński
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, University of Technology, 20-618 Lublin, Poland; (D.G.)
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Mongodi S, Salve G, Ravasi M, Rizzi D, Mangiagalli M, Musella V, Klersy C, Ansaloni L, Mojoli F. The mental health toll of COVID-19: significant increase in admissions to ICU for voluntary self-inflicted injuries after the beginning of the pandemic. Int J Ment Health Syst 2023; 17:22. [PMID: 37454115 DOI: 10.1186/s13033-023-00590-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND COVID-19 outbreak deeply impacted on mental health, with high rate of psychological distress in healthcare professionals, patients and general population. Current literature on trauma showed no increase in ICU admissions for deliberate self-inflicted injuries in the first weeks after the beginning of COVID-19. OBJECTIVES We tested the hypothesis that self-inflicted injuries/harms of any method requiring ICU admission increased in the year following COVID-19 outbreak. METHODS Retrospective cohort single-center study comparing admissions to ICU the year before and the year after the pandemic start. All patients admitted to polyvalent ICUs-Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy from February 21st, 2019 to February 21st, 2020 (pre-COVID) and from February 22nd, 2020 to February 22nd, 2021 (post-COVID) were enrolled. RESULTS We enrolled 1038 pre-COVID and 854 post-COVID patients. In post-COVID, the incidence of self-inflicted injuries was 32/854 (3.8% [2.5-5.1]), higher than in pre-COVID (23/1038, 2.2%-p = 0.0014-relative increase 72.7%). The increase was more relevant when excluding COVID-19 patients (suicide attempts 32/697 (4.6% [3.0-6.2])-relative increase 109.1%; p < 0.0001). Both in pre-COVID and post-COVID, the most frequent harm mean was poisoning [15 (65.2%) vs. 25 (78.1%), p = 0.182] and the analysed population was younger than general ICU population (p = 0.0015 and < 0.0001, respectively). The distribution of admissions for self-inflicted injuries was homogeneous in pre-COVID along the year. In post-COVID, no admissions were registered during the lockdown; an increase was observed in summer with pandemic curve at minimal levels. CONCLUSIONS An increase in ICU admissions for self-inflicted injuries/harms was observed in the year following COVID-19 outbreak.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Giulia Salve
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | - Marta Ravasi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | - Damiano Rizzi
- Psychology department, Fondazione Soleterre, Milan, Italy
- Emergency Room, Department of Intensive Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Mangiagalli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
- Psychology department, Fondazione Soleterre, Milan, Italy
| | - Valeria Musella
- Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Ansaloni
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
- General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
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Pettke A, Stassen W, Laflamme L, Wallis LA, Hasselberg M. Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa. BMC Emerg Med 2023; 23:72. [PMID: 37370047 DOI: 10.1186/s12873-023-00840-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). METHODS We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019-01-01 and 2021-02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. RESULTS During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response- and on-scene time remained stable in the time-periods studied. CONCLUSION This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions.
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Affiliation(s)
- Aleksandra Pettke
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| | - Lee Alan Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Marincowitz C, Bouamra O, Coats T, Kumar D, Lockey D, Mason L, Newcombe V, Thompson J, Edwards A, Lecky F. Major trauma presentations and patient outcomes in English hospitals during the COVID-19 pandemic: An observational cohort study. PLoS Med 2023; 20:e1004243. [PMID: 37315103 DOI: 10.1371/journal.pmed.1004243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Single-centre studies suggest that successive Coronavirus Disease 2019 (COVID-19)-related "lockdown" restrictions in England may have led to significant changes in the characteristics of major trauma patients. There is also evidence from other countries that diversion of intensive care capacity and other healthcare resources to treating patients with COVID-19 may have impacted on outcomes for major trauma patients. We aimed to assess the impact of the COVID-19 pandemic on the number, characteristics, care pathways, and outcomes of major trauma patients presenting to hospitals in England. METHODS AND FINDINGS We completed an observational cohort study and interrupted time series analysis including all patients eligible for inclusion in England in the national clinical audit for major trauma presenting between 1 January 2017 and 31 of August 2021 (354,202 patients). Demographic characteristics (age, sex, physiology, and injury severity) and clinical pathways of major trauma patients in the first lockdown (17,510 patients) and second lockdown (38,262 patients) were compared to pre-COVID-19 periods in 2018 to 2019 (comparator period 1: 22,243 patients; comparator period 2: 18,099 patients). Discontinuities in trends for weekly estimated excess survival rate were estimated when lockdown measures were introduced using segmented linear regression. The first lockdown had a larger associated reduction in numbers of major trauma patients (-4,733 (21%)) compared to the pre-COVID period than the second lockdown (-2,754 (6.7%)). The largest reductions observed were in numbers of people injured in road traffic collisions excepting cyclists where numbers increased. During the second lockdown, there were increases in the numbers of people injured aged 65 and over (665 (3%)) and 85 and over (828 (9.3%)). In the second week of March 2020, there was a reduction in level of major trauma excess survival rate (-1.71%; 95% CI: -2.76% to -0.66%) associated with the first lockdown. This was followed by a weekly trend of improving survival until the lifting of restrictions in July 2020 (0.25; 95% CI: 0.14 to 0.35). Limitations include eligibility criteria for inclusion to the audit and COVID status of patients not being recorded. CONCLUSIONS This national evaluation of the impact of COVID on major trauma presentations to English hospitals has observed important public health findings: The large reduction in overall numbers injured has been primarily driven by reductions in road traffic collisions, while numbers of older people injured at home increased over the second lockdown. Future research is needed to better understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first lockdown.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Omar Bouamra
- Trauma Audit Research Network, University of Manchester, Manchester, United Kingdom
| | - Tim Coats
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Dhushy Kumar
- Department of Critical Care, Anaesthesia and Pre-hospital Emergency Medicine, University Hospital Coventry, Coventry, United Kingdom
| | - David Lockey
- London's Air Ambulance, Royal London Hospital, London, United Kingdom
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Lyndon Mason
- Liverpool University Hospitals NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Julian Thompson
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Antoinette Edwards
- Trauma Audit Research Network, University of Manchester, Manchester, United Kingdom
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- Trauma Audit Research Network, University of Manchester, Manchester, United Kingdom
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12
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Auger N, Lewin A, Brousseau É, Ayoub A, Blaser C, Luu TM. Lockdowns and cycling injuries: temporal analysis of rates in Quebec during the first year of the pandemic. Health Promot Chronic Dis Prev Can 2023; 43:330-337. [PMID: 37466398 PMCID: PMC10414814 DOI: 10.24095/hpcdp.43.7.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Cycling increased in popularity during the COVID-19 pandemic, but the impact on cycling injuries is not known. We examined the effect of lockdowns on cycling injury hospitalizations. METHODS We identified hospitalizations for cycling injuries in Quebec, Canada, between April 2006 and March 2021. We used rate ratios (RR) and 95% confidence intervals (CI) to compare hospitalization rates by type of cycling injury and anatomical site during two waves of the pandemic. We performed interrupted time series regression to assess the effect of lockdowns on monthly cycling injury hospitalization rates, according to age, sex and other characteristics. RESULTS There were 2020 hospitalizations for cycling injuries between March 2020 and March 2021, including 617 during the first lockdown and 67 during the second lockdown. Compared with the period before the pandemic, risk of cycling-related injuries during the first lockdown increased the most for fractures (RR = 1.44; 95% CI: 1.26- 1.64) and head and neck injuries (RR = 1.59; 95% CI: 1.19-2.12). Cycling injury hospitalization rates increased significantly among adults, adolescents and individuals from socioeconomically advantaged neighbourhoods or those with low concentrations of racialized people every month of the first lockdown. The second lockdown was not associated with cycling injuries. CONCLUSION The first lockdown triggered a sharp increase in cycling injury hospitalizations, especially among adults, adolescents and individuals from socioeconomically advantaged and less racialized neighbourhoods.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Montréal, Quebec, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Christine Blaser
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, Université de Montréal, Montréal, Quebec, Canada
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13
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Gobetti JSC, Zraik MB, Afornali CB, Goveia CHM, Naufel Junior CR, Coelho GA, Nunes SGB, Simm EB. Comparative analysis of the trauma care profile before and during the COVID-19 pandemic: a cross-sectional study in a tertiary university hospital. Rev Col Bras Cir 2023; 50:e20233449. [PMID: 36921134 PMCID: PMC10519697 DOI: 10.1590/0100-6991e-20233449-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. METHODS quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. RESULTS there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. CONCLUSION there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.
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Affiliation(s)
| | - Mariam Bleibel Zraik
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
| | | | | | - Carlos Roberto Naufel Junior
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
| | - Guilherme Andrade Coelho
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
| | - Suelen Geisemara Barcelar Nunes
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
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14
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Facial Trauma Management During the Coronavirus Disease 2019 Pandemic. J Craniofac Surg 2023; 34:955-958. [PMID: 36727751 PMCID: PMC10128424 DOI: 10.1097/scs.0000000000009177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Facial trauma is managed with open or closed treatment modalities; however, the impact of the coronavirus disease 2019 (COVID-19) pandemic on facial trauma management remains unclear. OBJECTIVE To determine whether the management of facial trauma varied during the COVID-19 pandemic. DESIGN SETTING, PARTICIPANTS A retrospective review of 127 adults at The R Adams Cowley Shock Trauma Center at the University of Maryland between March 2019 and March 2021. Adults were stratified into pre-COVID (before March 2020) and post-COVID groups. MAIN OUTCOMES AND MEASURES Open reduction internal fixation alone, maxillomandibular fixation (MMF) alone, Open reduction internal fixation and MMF, and closed reduction. RESULTS Of the 127 patients, 66 were treated pre-COVID (52%) and 61 post-COVID (48%). While the prevalence of mandible fractures did not differ (pre-COVID, n = 39, 59%; post-COVID, n = 42, 69%; P = 0.33), the use of MMF alone decreased (pre-COVID, n = 9, 23%; post-COVID, n = 1, 2%; P = 0.005). In contrast, while the prevalence of displaced nasal bone fractures decreased (pre-COVID, n = 21, 32%; post-COVID, n = 4, 7%; P = 0.0007), management with closed reduction did not differ (pre-COVID, n = 23, 96%; post-COVID, n = 11, 85%; P = 0.27). CONCLUSIONS AND RELEVANCE Although the clinical characteristics of patients with facial fractures did not differ during the COVID-19 pandemic, the use of MMF for mandible fractures changed significantly. LEVEL OF EVIDENCE Level IV.
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15
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Alharbi RJ, Al-Jafar R, Chowdhury S, Rahman MA, Almuwallad A, Alshibani A, Lewis V. Impact of easing COVID-19 lockdown restrictions on traumatic injuries in Riyadh, Saudi Arabia: one-year experience at a major trauma centre. BMC Public Health 2023; 23:22. [PMID: 36600205 PMCID: PMC9812537 DOI: 10.1186/s12889-023-14981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Lockdown restrictions due to the COVID-19 pandemic have reduced the number of injuries recorded. However, little is known about the impact of easing COVID-19 lockdown restrictions on the nature and outcome of injuries. This study aims to compare injury patterns prior to and after the easing of COVID-19 lockdown restrictions in Saudi Arabia. METHOD Data were collected retrospectively from the Saudi TraumA Registry for the period between March 25, 2019, and June 21, 2021. These data corresponded to three periods: March 2019-February 2020 (pre-restrictions, period 1), March 2020-June 2020 (lockdown, period 2), and July 2020-June 2021 (post easing of restrictions, period 3). Data related to patients' demographics, mechanism and severity of injury, and in-hospital mortality were collected and analysed. RESULTS A total of 5,147 traumatic injury patients were included in the analysis (pre-restrictions n = 2593; lockdown n = 218; post easing of lockdown restrictions n = 2336). An increase in trauma cases (by 7.6%) was seen in the 30-44 age group after easing restrictions (n = 648 vs. 762, p < 0.01). Motor vehicle crashes (MVC) were the leading cause of injury, followed by falls in all the three periods. MVC-related injuries decreased by 3.1% (n = 1068 vs. 890, p = 0.03) and pedestrian-related injuries decreased by 2.7% (n = 227 vs. 143, p < 0.01); however, burn injuries increased by 2.2% (n = 134 vs. 174, p < 0.01) and violence-related injuries increased by 0.9% (n = 45 vs. 60, p = 0.05) post easing of lockdown restrictions. We observed an increase in in-hospital mortality during the period of 12 months after easing of lockdown restrictions-4.9% (114/2336) compared to 12 months of pre-lockdown period-4.3% (113/2593). CONCLUSION This is one of the first studies to document trauma trends over a one-year period after easing lockdown restrictions. MVC continues to be the leading cause of injuries despite a slight decrease; overall injury cases rebounded towards pre-lockdown levels in Saudi Arabia. Injury prevention needs robust legislation with respect to road safety measures and law enforcement that can decrease the burden of traumatic injuries.
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Affiliation(s)
- Rayan Jafnan Alharbi
- grid.411831.e0000 0004 0398 1027Department of Emergency Medical Service, College of Applied Medical Sciences, Jazan University, 45142, Al Maarefah Rd, Jazan, Saudi Arabia
| | - Rami Al-Jafar
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK ,Department of Data Services, Lean Business Services, Riyadh, Saudi Arabia
| | - Sharfuddin Chowdhury
- grid.415998.80000 0004 0445 6726Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Muhammad Aziz Rahman
- grid.1040.50000 0001 1091 4859School of Health, Federation University Australia, Berwick, VIC Australia
| | - Ateeq Almuwallad
- grid.411831.e0000 0004 0398 1027Department of Emergency Medical Service, College of Applied Medical Sciences, Jazan University, 45142, Al Maarefah Rd, Jazan, Saudi Arabia ,grid.4868.20000 0001 2171 1133Centre for Trauma Science, Blizard Institute Queen Mary University, London, UK
| | - Abdullah Alshibani
- grid.412149.b0000 0004 0608 0662Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Virginia Lewis
- grid.1018.80000 0001 2342 0938Australia Institute for Primary Care and Ageing (AIPCA), La Trobe University, Melbourne, VIC Australia
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Banks KC, Mooney CM, Borthwell R, Victorino K, Coutu S, Mazzolini K, Dzubnar J, Browder TD, Victorino GP. Racial Disparities Among Trauma Patients During the COVID-19 Pandemic. J Surg Res 2023; 281:89-96. [PMID: 36137357 PMCID: PMC9420714 DOI: 10.1016/j.jss.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Given the disparate effects of the COVID-19 pandemic on people of color, we hypothesized that patients of color experienced a disproportionate increase in trauma during the COVID-19 pandemic. MATERIALS AND METHODS We compared trauma patients arriving in the 3 y before our statewide stay-at-home mandate on March 20, 2020 (PRE) to those arriving in the year afterward (POST). In addition to race/ethnicity, we assessed patient demographics and other clinical variables. Chi-squared, Fisher's exact, and Mann-Whitney U tests were used for univariate analyses. A multivariable logistic regression was performed to assess for associations with mortality. RESULTS During the study period, 8583 patients were included in the PRE group and 2883 were included in the POST group. There were increases in penetrating trauma (PRE 14.7%, POST 23.1%; P < 0.001) and mortality rates (PRE 3.20%, POST 4.60%; P < 0.001). From PRE to POST, the percentage of Black patients increased from 35.0% to 38.3% (P = 0.01) and the percentage of Hispanic patients increased from 19.2% to 23.0% (P < 0.001). After a multivariable analysis, Asian patients experienced an independent increase in mortality from PRE to POST (odds ratio 2.00, 95% confidence interval 1.13-3.54, P = 0.02). CONCLUSIONS Penetrating trauma and mortality rates increased during the pandemic. There was a simultaneous increase in the percentage of Black and Hispanic trauma patients. Asian patient mortality increased significantly after the start of the pandemic independent of other variables. Identifying racial/ethnic disparities is the first step in finding ways to improve dissimilar outcomes.
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Affiliation(s)
- Kian C Banks
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
| | - Colin M Mooney
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Rachel Borthwell
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kealia Victorino
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Sophia Coutu
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Kirea Mazzolini
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Jessica Dzubnar
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Timothy D Browder
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Gregory P Victorino
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
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Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry 2022; 221:603-612. [PMID: 35816104 DOI: 10.1192/bjp.2022.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. AIMS To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. METHOD A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. RESULTS Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. CONCLUSIONS Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK
| | - Ann John
- Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK
| | - David J Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dana Dekel
- Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK
| | - Lena Schmidt
- Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK
| | - Julian P T Higgins
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Luke A McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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Koruga N, Soldo Koruga A, Rončević R, Turk T, Kopačin V, Kretić D, Rotim T, Rončević A. Telemedicine in Neurosurgical Trauma during the COVID-19 Pandemic: A Single-Center Experience. Diagnostics (Basel) 2022; 12:diagnostics12092061. [PMID: 36140463 PMCID: PMC9497489 DOI: 10.3390/diagnostics12092061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Telemedicine is a rapid tool that reduces the time until treatment for patients, which is especially useful for neurosurgical trauma. The aim of our study was to evaluate the use of telemedicine in neurosurgery during the COVID-19 pandemic compared with the pre-pandemic era. We assessed the utilization of telemedicine at the Department of Neurosurgery at University Hospital Center Osijek in Croatia over a timespan of one year prior to the COVID-19 pandemic and the first year of the pandemic, starting with the date of first lockdown in Croatia. For each time period, the total number of consults and specific clinical inquiries were recorded and adequately grouped as well as comprehensive patient characteristics. There were 336 consults in the pre-pandemic period and 504 in the pandemic period. The number of trauma-related consults during COVID-19 measures was significantly higher than the pre-pandemic era (288 and 138, respectively, p < 0.0001). Neurosurgical trauma patients requiring consults in the pandemic period were significantly older than before the pandemic (64.9 ± 18.5 and 60.6 ± 19.1, respectively, p = 0.03). Significantly, the number of admissions to our center and urgent surgeries did not significantly differ between these periods. Telemedicine is a cost-effective tool in the neurosurgical evaluation of patients, especially for trauma. The COVID-19 pandemic accelerated telemedicine implementation and improved neurosurgical trauma treatments.
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Affiliation(s)
- Nenad Koruga
- Department of Neurosurgery, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Neurology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Robert Rončević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Tajana Turk
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Vjekoslav Kopačin
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Domagoj Kretić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Tatjana Rotim
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Alen Rončević
- Department of Neurosurgery, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence: ; Tel.: +385-98-1698481
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19
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Impact of COVID-19 Pandemic on Trauma CT Imaging. Radiol Res Pract 2022; 2022:9596148. [PMID: 35694183 PMCID: PMC9184200 DOI: 10.1155/2022/9596148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The goal of this study was to understand the impact of COVID-19 pandemic and associated lockdown measures on the volume, rate, and type of trauma presenting to the emergency department (ED) by using trauma-initiated CT studies to capture patient data. Materials and Methods We performed a retrospective observational study comparing patients undergoing CT scans for trauma during the 1st and 2nd lockdown periods compared to corresponding prepandemic months. During two lockdown periods, public places such as restaurants, libraries, parks, and shops across the province were shut down. Government-led messaging advised that people should stay at home and practice social distancing. The rate of trauma-initiated CT scans and the proportion of different types of traumas were compared between time periods. Results There was no significant difference in overall trauma-initiated CT scans between the prepandemic and pandemic levels. Motor vehicle collision (MVC) cases decreased from 18.2% to 15.6% during the first lockdown period (p = 0.049) and also reduced from 29.1% to 25.2% during the second lockdown period (p = 0.013). Trauma from falls increased from 19.1% to 27.5% (p = 0.036) during the first lockdown, despite no significant change during the 2nd lockdown. Furthermore, the percentage of stab injuries increased from 25.0% to 38.9% while blunt trauma decreased from 68.5% to 54.3% during two lockdowns (p = 0.015). Conclusion The total number of trauma-initiated CT scans did not significantly decrease during the lockdown periods. Stabbings and falls increased during lockdown periods while MVCs and blunt trauma decreased.
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20
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Bhattacharya R, Pearse M, Bates P, Tahmassebi R, El-Daly I, Jeyaseelan L, Sedgwick P, Trompeter A. The impact of COVID-19 on major trauma (ISS>15) in London, across its four Level 1 centres. Ann R Coll Surg Engl 2022; 104:437-442. [PMID: 34845936 PMCID: PMC9158040 DOI: 10.1308/rcsann.2021.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to reconfiguration of healthcare resources to manage increased demand for acute hospital beds and intensive care places. Concerns were raised regarding continuing provision of critical care for non-COVID patients during the pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on patients admitted with major trauma (Injury Severity Score >15) across the four Level 1 trauma centres in London. METHODS Data were collected from all four major trauma centres (MTCs) in London using the Trauma Audit and Research Network database and from local databases at each centre. A 2-month period from 5 March to 5 May 2020 was selected and the same period during 2019 was used to compare changes due to the pandemic. RESULTS There was a 31% decrease in overall number of patients presenting to the four MTCs during the COVID-19 period compared with 2019. There was no difference in patient demographics or mechanism of injury between the two periods. Sports-related injuries and proportion of self-presentation to hospital were reduced slightly during the pandemic, although the differences were not statistically significant. The mortality rate and association between mortality and injury severity were similar. Proportion of patients requiring intensive care unit facilities also did not change. CONCLUSION Despite diversion of critical care resources to deal with COVID-related admissions, we did not observe a change in mortality rate or proportion of severely injured patients requiring critical care. Our results suggest London MTCs were able to provide their usual standard of care for critically injured major trauma (Injury Severity Score >15) patients during the pandemic.
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Affiliation(s)
| | - M Pearse
- Imperial College Healthcare NHS Trust, UK
| | | | - R Tahmassebi
- King’s College Hospital NHS Foundation Trust, UK
| | - I El-Daly
- King’s College Hospital NHS Foundation Trust, UK
| | | | - P Sedgwick
- St George’s University Hospitals NHS Foundation Trust, UK
| | - A Trompeter
- St George’s University Hospitals NHS Foundation Trust, UK
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21
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NYGREN H, KOPRA J, KRÖGER H, KUITUNEN I, MATTILA VM, PONKILAINEN V, RIKKONEN T, SUND R, SIROLA J. The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals. Acta Orthop 2022; 93:360-366. [PMID: 35257188 PMCID: PMC8902588 DOI: 10.2340/17453674.2022.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019. PATIENTS AND METHODS The data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18-May 31, 2020) and the reference period (March 18-May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model. RESULTS The overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI -18 to -13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI -59 to -9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI -52 to -5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI -71 to -22) among women. The number of ED visits due to hip fractures increased by 2% (CI -16 to 24). INTERPRETATION Restrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.
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Affiliation(s)
- Henri NYGREN
- University of Eastern Finland, School of Medicine, Kuopio
| | - Juho KOPRA
- University of Eastern Finland, School of Medicine, Kuopio
| | - Heikki KRÖGER
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
| | - Ilari KUITUNEN
- University of Eastern Finland, School of Medicine, Kuopio,Mikkeli Central Hospital, Mikkeli
| | - Ville M MATTILA
- Department of Orthopaedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere
| | | | - Toni RIKKONEN
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Reijo SUND
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Joonas SIROLA
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
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22
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Alao DO, Cevik AA, Yasin YJ, Jaiganesh T, Abu-Zidan F. The COVID-19 pandemic reduced the trauma incidence and modified its pattern in Al-Ain City, United Arab Emirates. Eur J Trauma Emerg Surg 2022; 48:3011-3016. [PMID: 35178582 PMCID: PMC8853936 DOI: 10.1007/s00068-022-01897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
AIM We aimed to study the impact of the COVID-19 pandemic on the pattern of injury and outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates, to use this information in the preparedness for future pandemics. METHODS We retrospectively compared the trauma registry data of all hospitalised trauma patients, who were treated at the two main trauma centres in Al-Ain City (Al-Ain Hospital and Tawam Hospital); those who were treated over 1 year before the pandemic (n = 2002) and those who were treated at the first year of the COVID-19 pandemic (n = 1468). RESULTS There was a 26.7% reduction in the overall incidence of trauma admissions in the COVID-19 pandemic period. The mechanism of injury significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase in the number of injuries, due to machinery and falling objects during the pandemic (39.7% and 54.1% respectively, p < 0.001). In contrast, road traffic collisions and falls were reduced by 33.5% and 31.3%, respectively. Location significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase of 18.4% in workplace injuries and a reduction of 39.3% in home injuries over the study period. In addition, we observed relatively more workplace injuries and fewer home injuries during the pandemic (11.3% and 42.8% compared with 7.1% and 52.4%, respectively). Mortality was similar between the two periods (1.8% compared with 1.2%, p = 0.16, Fisher's exact test). CONCLUSIONS The COVID-19 pandemic has modified the trauma risk exposure in our population. It reduced trauma hospital admissions by around 27%. Work-related injuries, including falling objects and machinery injuries, were relatively higher during the pandemic. Prevention of work-related injuries should be an important component of preparedness for future pandemics.
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Affiliation(s)
- David Olukolade Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. .,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Yasin Jemal Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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23
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Trier F, Fjølner J, Raaber N, Sørensen AH, Kirkegaard H. Effect of the COVID-19 pandemic at a major Danish trauma center in 2020 compared with 2018-2019: A retrospective cohort study. Acta Anaesthesiol Scand 2022; 66:265-272. [PMID: 34748218 PMCID: PMC8653017 DOI: 10.1111/aas.13997] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- Frederik Trier
- Department of Clinical Medicine Research Center for Emergency Medicine Aarhus University Aarhus Denmark
| | - Jesper Fjølner
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
- Research and Development Prehospital Emergency Medical Services Central Denmark Region Aarhus Denmark
| | - Nikolaj Raaber
- Emergency Department Research Center for Emergency Medicine Aarhus University Hospital Aarhus Denmark
- Research and Development Prehospital Emergency Medical Services Central Denmark Region Aarhus Denmark
| | - Anders H. Sørensen
- Emergency Department Research Center for Emergency Medicine Aarhus University Hospital Aarhus Denmark
| | - Hans Kirkegaard
- Department of Clinical Medicine Research Center for Emergency Medicine Aarhus University Aarhus Denmark
- Emergency Department Research Center for Emergency Medicine Aarhus University Hospital Aarhus Denmark
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24
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Yu H, Xu M, Zhao Y, Li J, Wu W, Feng Y. COVID-19 Changed Prevalence, Disease Spectrum and Management Strategies of Ocular Trauma. Front Med (Lausanne) 2022; 8:774493. [PMID: 35083239 PMCID: PMC8784966 DOI: 10.3389/fmed.2021.774493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health of people around the world and has reshaped social behaviors and clinical practice. The purpose of this perspective is to provide epidemiologists and clinicians with information about how the spectrum of ocular trauma diseases changed, as well as to optimize management for improving patient prognosis during this crisis. Analysis of current studies revealed that the prevalence of eye trauma decreased overall, with a trend of delayed medical treatment during the COVID-19 era. Irregular epidemic prevention and control measures, unprotected home activities, and unusual mental states are the main causes of ocular trauma. Strategies for reducing morbidity are also discussed, including popularizing the use norms of prevention and control supplies, taking heed to the safety of family activities, highlighting the special status of child protection, and paying attention to previous case data to implement region-specific precautions. The procedure of ophthalmological emergency and outpatient management should also be optimized, and mental health should be emphasized during this pandemic.
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Affiliation(s)
- Haozhe Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Minhui Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yue Zhao
- Institute of Medical Education, Peking University, Beijing, China
| | - Jingyi Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Wenyu Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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25
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Mazzolini K, Dzubnar J, Kwak H, Banks K, Mooney C, Tang A, Cohan C, Browder T. An Epidemic Within the Pandemic: The Rising Tide of Trauma DuringCOVID-19. J Surg Res 2021; 272:139-145. [PMID: 34971837 PMCID: PMC8654586 DOI: 10.1016/j.jss.2021.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
Background In the age of COVID-19 and enforced social distancing, changes in patterns of trauma were observed but poorly understood. Our aim was to characterize traumatic injury mechanisms and acuities in 2020 and compare them with previous years at our level I trauma center. Material and methods Patients with trauma triaged in 2016 through 2020 from January to May were reviewed. Patient demographics, level of activation (1 versus 2), injury severity score, and mechanism of injury were collected. Data from 2016 through 2019 were combined, averaged by month, and compared with data from 2020 using chi-squared analysis. Results During the months of interest, 992 patients with trauma were triaged in 2020 and 4311 in 2016-2019. The numbers of penetrating and level I trauma activations in January-March of 2020 were similar to average numbers for the same months during 2016 through 2019. In April 2020, there was a significant increase in the incidence of penetrating trauma compared with the prior 4-year average (27% versus 16%, P < 0.002). Level I trauma activations in April 2020 also increased, rising from 17% in 2016 through 2019 to 32% in 2020 (P < 0.003). These findings persisted through May 2020 with similarly significant increases in penetrating and high-level trauma. Conclusions In the months after the initial spread of COVID-19, there was a perceptible shift in patterns of trauma. The significant increase in penetrating and high-acuity trauma may implicate a change in population dynamics, demanding a need for thoughtful resource allocation at trauma centers nationwide in the context of a global pandemic.
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Affiliation(s)
- Kirea Mazzolini
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Jessica Dzubnar
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Hyunjee Kwak
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kian Banks
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Colin Mooney
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Annie Tang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Caitlin Cohan
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Timothy Browder
- Department of Surgery, University of California San Francisco, San Francisco, California
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26
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Trauma in Children during Lockdown for SARS-CoV-2 Pandemic. A Brief Report. CHILDREN 2021; 8:children8121131. [PMID: 34943327 PMCID: PMC8700384 DOI: 10.3390/children8121131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
Purpose: The national lockdown established by the Italian government began on the 11th of March 2020 as a means to control the spread of SARS-CoV-2 infections. The purpose of this brief report is to evaluate the effect of the national lockdown on the occurrence and characteristics of trauma in children during lockdown. Methods: All children admitted to our paediatric orthopaedic unit with a diagnosis of fracture or trauma, including sprains and contusions, between 11 March 2020 and 11 April 2020, were retrospectively reviewed. Their demographic data, type of injury, anatomical location and need for hospitalisation were compared with the equivalent data of children admitted for trauma in the same period of 2018 and 2019. Results: Sixty-nine patients with trauma were admitted in 2020, with a significant decrease in comparison with 2019 (n = 261) and 2018 (n = 289) (p < 0.01). The patients were significantly younger, and the rate of fractures significantly increased in 2020 (p < 0.01). Conclusions: Home confinement decreased admissions to the emergency department for trauma by shutting down outdoor activities, schools and sports activities. However, the rate of fractures increased in comparison with minor trauma, involved younger children and had a worse prognosis.
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27
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Yasin YJ, Alao DO, Grivna M, Abu-Zidan FM. Impact of the COVID-19 Pandemic on road traffic collision injury patterns and severity in Al-Ain City, United Arab Emirates. World J Emerg Surg 2021; 16:57. [PMID: 34798873 PMCID: PMC8602977 DOI: 10.1186/s13017-021-00401-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 Pandemic lockdowns restricted human and traffic mobility impacting the patterns and severity of road traffic collisions (RTCs). We aimed to study the effects of the COVID-19 Pandemic on incidence, patterns, severity of the injury, and outcomes of hospitalized RTCs trauma patients in Al-Ain City, United Arab Emirates. Methods We compared the data of two cohorts of patients which were collected over two periods; the Pandemic period (28 March 2020 to 27 March 2021) and the pre-pandemic period (28 March 2019 to 27 March 2020). All RTCs trauma patients who were hospitalized in the two major trauma centers (Al-Ain and Tawam Hospitals) of Al-Ain City were studied. Results Overall, the incidence of hospitalized RTC trauma patients significantly reduced by 33.5% during the Pandemic compared with the pre-pandemic period. The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher’s Exact test). MVCs were less during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3% compared with 11.2%). The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4% compared with 2.3%, p = 0.045, Fisher’s Exact test). Logistic regression showed that the significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality. Conclusions Our study has shown that the numbers of hospitalized RTC trauma patients reduced by 33.5% during the COVID-19 Pandemic compared with the pre-pandemic period in our setting. This was attributed to the reduced motor vehicle, pedestrian and bicycle injuries while motorcycle injuries increased. Mortality was significantly higher during the Pandemic, which was attributed to increased ISS and reduced GCS.
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Affiliation(s)
- Yasin J Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
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28
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Beiter K, Hayden E, Phillippi S, Conrad E, Hunt J. Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma. Am J Surg 2021; 222:922-932. [PMID: 34148669 PMCID: PMC8129999 DOI: 10.1016/j.amjsurg.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.
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Affiliation(s)
- Kaylin Beiter
- Louisiana State University Health Sciences Center, United States.
| | - Ellery Hayden
- Louisiana State University Health Sciences Center, United States
| | | | - Erich Conrad
- Louisiana State University Health Sciences Center, United States
| | - John Hunt
- Louisiana State University Health Sciences Center, United States
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29
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Yasin YJ, Grivna M, Abu-Zidan FM. Global impact of COVID-19 pandemic on road traffic collisions. World J Emerg Surg 2021; 16:51. [PMID: 34583713 PMCID: PMC8478263 DOI: 10.1186/s13017-021-00395-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Various strategies to reduce the spread of COVID-19 including lockdown and stay-at-home order are expected to reduce road traffic characteristics and consequently road traffic collisions (RTCs). We aimed to review the effects of the COVID-19 pandemic on the incidence, patterns, and severity of the injury, management, and outcomes of RTCs and give recommendations on improving road safety during this pandemic. METHODS We conducted a narrative review on the effects of COVID-19 pandemic on RTCs published in English language using PubMed, Scopus, and Google Scholar with no date restriction. Google search engine and websites were also used to retrieve relevant published literature, including discussion papers, reports, and media news. Papers were critically read and data were summarized and combined. RESULTS Traffic volume dropped sharply during the COVID-19 pandemic which was associated with significant drop in RTCs globally and a reduction of road deaths in 32 out of 36 countries in April 2020 compared with April 2019, with a decrease of 50% or more in 12 countries, 25 to 49% in 14 countries, and by less than 25% in six countries. Similarly, there was a decrease in annual road death in 33 out of 42 countries in 2020 compared with 2019, with a reduction of 25% or more in 5 countries, 15-24% in 13 countries, and by less than 15% in 15 countries. In contrast, the opposite occurred in four and nine countries during the periods, respectively. There was also a drop in the number of admitted patients in trauma centers related to RTCs during both periods. This has been attributed to an increase in speeding, emptier traffic lanes, reduced law enforcement, not wearing seat belts, and alcohol and drug abuse. CONCLUSIONS The COVID-19 pandemic has generally reduced the overall absolute numbers of RTCs, and their deaths and injuries despite the relative increase of severity of injury and death. The most important factors that affected the RTCs are decreased mobility with empty lines, reduced crowding, and increased speeding. Our findings serve as a baseline for injury prevention in the current and future pandemics.
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Affiliation(s)
- Yasin J. Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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30
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Hickland MM, Massouh P, Sutthakorn RE, Greenslade C, Jennings C, Cantle F, Bew D. The impact of the COVID-19 pandemic on the number of presentations of penetrating injuries to a UK major trauma centre. J Public Health (Oxf) 2021; 44:e126-e132. [PMID: 34428291 PMCID: PMC8499749 DOI: 10.1093/pubmed/fdab333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/16/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Background Knife-related violence is of growing concern in the UK. This study aims to investigate the impact of the COVID-19 pandemic on the frequency of penetrating injuries at a UK major trauma centre. Methods This was a retrospective study comparing the number of patients attending the emergency department of King’s College Hospital (KCH) with a penetrating injury (gunshot or stab wound) during the ‘pandemic year’ (1 March 2020–28 February 2021) compared with the equivalent time period in the previous year. Penetrating injuries as a result of self-harm were excluded. The primary outcome was to assess whether there were any changes to the frequency of presentations during three periods of national lockdowns. Results Lockdown 1 showed a 48.45% reduction in presentations in the ‘pandemic year’ compared to the previous year, lockdown 2 showed a 31.25% reduction; however, lockdown 3 showed an 8.89% increase in the number of presentations. Conclusion Our findings suggest that despite the initial reduction in the number of presentations of penetrating injury during lockdown 1, this returned to normal levels by lockdown 3. Further research is required to understand the effects of government-imposed restrictions on interpersonal violence and identify appropriate methods of outreach prevention during a pandemic.
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Affiliation(s)
- Maria M Hickland
- GKT School of Medical Education, King's College London, London SE1 1UL, UK
| | - Philippa Massouh
- GKT School of Medical Education, King's College London, London SE1 1UL, UK
| | | | | | - Cara Jennings
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Fleur Cantle
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Duncan Bew
- Department of Trauma and Acute Surgery, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
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Huang W, Lin Q, Xu F, Chen D. Effect of COVID-19 on epidemiological characteristics of road traffic injuries in Suzhou: a retrospective study. BMC Emerg Med 2021; 21:88. [PMID: 34311702 PMCID: PMC8312208 DOI: 10.1186/s12873-021-00483-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/19/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To present the new trends in epidemiology of road traffic injuries (RTIs) during the Coronavirus disease 2019 (COVID-19) pandemic in Suzhou. METHODS Pre-hospital records of RTIs from January to May in 2020 and the same period in 2019 were obtained from the database of Suzhou pre-hospital emergency center, Jiangsu, China. Data were extracted for analysis, including demographic characteristics, pre-hospital vital signs, transport, shock index, consciousness, pre-hospital death. A retrospective study comparing epidemiological characteristics of RTIs in Suzhou during the 5-month period in 2020 to the parallel period in 2019 was performed. RESULTS A total of 7288 RTIs in 2020 and 8869 in 2019 met inclusion criteria. The overall volume of RTIs has statistical difference between the 2 years (p < 0.001), with fewer RTIs in 2020 compared with 2019. Electric bicycle related RTIs increased during the pandemic (2641, 36.24% vs 2380, 26.84%, p < 0.001), with a higher incidence of RTIs with disorder of consciousness (DOC) (7.22% vs 6.13%, p = 0.006). CONCLUSIONS Under the impact of COVID-19, the total number of RTIs in Suzhou from January to May 2020 decreased. This observation was coupled with a rise in electric bicycle related injuries and an increase in the incidence of RTIs with DOC.
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Affiliation(s)
- Wenjuan Huang
- Department of Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Qi Lin
- Suzhou Emergency Center, Suzhou City, Jiangsu Province, China
| | - Feng Xu
- Department of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Du Chen
- Department of Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China.
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Hakeem FF, Alshahrani SM, Ghobain MA, Albabtain I, Aldibasi O, Alghnam S. The Impact of COVID-19 Lockdown on Injuries in Saudi Arabia: Results From a Level-I Trauma Center. Front Public Health 2021; 9:704294. [PMID: 34327189 PMCID: PMC8315266 DOI: 10.3389/fpubh.2021.704294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/18/2021] [Indexed: 01/21/2023] Open
Abstract
Background: The COVID-19 pandemic has placed an enormous strain on global health. Due to precautionary measures, the epidemiology of health conditions may have been affected. Saudi Arabia imposed a lockdown order on March 25, 2020. This study investigated the impact of the pandemic lockdown on injuries in a level-I trauma center in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: This retrospective study identified all injured patients seeking emergency care during the lockdown period (March 25-June 21, 2020) and a similar period in two previous year (March 25-June 21) 2018 and 2019. The collected data included patients' demographics, injury types, mechanisms, and health outcomes. Results: Two hundred sixty nine injured patients sought emergency care during the lockdown, while 626 and 696 patients were treated in the same period of 2018 and 2019, respectively. There was a significant reduction in motor vehicle crashes (OR: 0.47; 95% CI: 0.31-0.73) and burns (OR: 0.24; 95% CI: 0.08-0.66), coupled with a significant increase in assault injuries (OR: 2.20; 95% CI: 1.30-3.74) in the lockdown period compared to 2019. Apart from the intensive care unit (ICU) admission and hospital length of stay, there were no differences between the two periods in the health outcomes. ICU admission was significantly reduced by 57% during the lockdown period (OR: 0.43; 95% CI: 0.22-0.83). Mechanisms of injuries were not significant predictors of deaths or ICU admission or both in the lockdown period. Conclusion: The COVID-19 lockdown had a clear impact on the volume and mechanisms of injuries. The findings highlight that injury risk factors are modifiable and emphasize the importance of public health measures for preventing injuries and the significance of maintaining trauma services capacity during pandemics.
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Affiliation(s)
- Faisal F Hakeem
- Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Saeed Mastour Alshahrani
- Basic Medical Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammed Al Ghobain
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Albabtain
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Omar Aldibasi
- Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Suliman Alghnam
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Population Health Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Trauma epidemiology after easing of lockdown restrictions: experience from a level-one major trauma centre in England. Eur J Trauma Emerg Surg 2021; 48:1471-1478. [PMID: 34173022 PMCID: PMC8231076 DOI: 10.1007/s00068-021-01725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022]
Abstract
Purpose The COVID-19 pandemic transformed the delivery of trauma care. We examined the effect of lockdown easing on trauma presentation and management from one Major Trauma Centre (MTC). Methods Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to our MTC with trauma. The first 47 days of lockdown (23rd March–9th May 2020, period 1) were compared with the next 47 (10th May–26th June 2020, period 2) and last (27th June–13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management and length of stay. Results 1249 patients were included; 62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs. 143) but rebounded by May (123 vs. 120 patients). Road traffic collisions increased over periods one–three (18.8% vs. 23% vs. 30.1%, p = 0.038); deliberate self-harm (DSH) increased in period two compared with one and three (6.3% vs. 3.4% vs. 1.4%, p = 0.03), respectively. When compared with 2019, the 2020 patient age was lower, with less trauma relating to alcohol (7.3% vs. 13.2%, p = 0.009), but more from DSH (3.6% vs. 2.1%, p = 0.10). In 2020 less patients were assessed by a consultant and trauma team, with a shorter stay in hospital and critical care. Conclusion This is the first study to document trauma trends through a lockdown and thereafter. After lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.
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Çiftci AB. Injury Mechanism, Volume, and Severity of General Surgical Trauma Patients During COVID-19 Lockdown. Cureus 2021; 13:e15914. [PMID: 34322354 PMCID: PMC8310610 DOI: 10.7759/cureus.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background After the declaration of the COVID-19 pandemic, countries have taken many restriction measures to reduce the spread of the virus and ensure the health system's proper functioning. Our knowledge about the general surgery trauma patients being affected by the restrictions is very limited. Objective To examine the association of the lockdown measurements during the COVID-19 pandemic with general surgical trauma patients' volume and severity at a university teaching hospital. Methods All patients admitted to the emergency department because of trauma and evaluated by the general surgery team were examined in two groups. The COVID-19 restrictions period (17 March 2020 - 31 May 2020) and the corresponding time last year (17 March 2019 - 31 May 2019). Demographic properties, injury mechanisms, emergency trauma scores (ETS), hospital length of stays (HLOS), intensive care unit (ICU) admission rates, surgical interventions, and mortality were compared. Results The number of patients in the restrictions period is 30% lower than the before COVID-19 cohort. ETS was significantly higher in the restrictions period compared to the previous year, whereas no significant difference was detected in terms of injury mechanisms between the groups (p=0.001 vs p=0.493, respectively). HLOS was found to be higher in the restrictions period (p=0.038). Conclusions Although there was a decrease in the number of general surgical trauma admissions, a significant increase in the severity of trauma was observed during COVID-19 restrictions. We hope these findings will help authorities to guide resource allocation in future pandemic waves.
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Affiliation(s)
- Ahmet Burak Çiftci
- General Surgery, University of Samsun, Samsun Training and Research Hospital, Samsun, TUR
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35
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Mohan K, McCabe P, Mohammed W, Hintze JM, Raza H, O'Daly B, Leonard M. Impact of the COVID-19 Pandemic on Pelvic and Acetabular Trauma: Experiences From a National Tertiary Referral Centre. Cureus 2021; 13:e15833. [PMID: 34322330 PMCID: PMC8297654 DOI: 10.7759/cureus.15833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on daily life. Restrictions imposed to help minimise virus transmission have limited both population movement and employment, as well as altering the potential mechanisms of high-energy trauma. The objective of this study was to assess the impact of the COVID-19 pandemic on pelvic and acetabular trauma. Materials and methods A retrospective observational study of the incidence, causality, patient profile, fracture morphology, and treatment strategy of pelvic and acetabular trauma managed in a national tertiary referral specialist pelvic and acetabular centre between the 1st of March and 1st of August 2020 was undertaken and compared to corresponding time periods in the two preceding years. Results A total of 78 patients were referred for management following pelvic and acetabular trauma during the study period with a mean age of 52 years (SD +/- 24.2). Overall, 45% and 42% of patients were referred following isolated pelvic or acetabular fractures respectively. The most frequent mechanism of injury was a fall from height (>1m) (42%), with 53% of patients suffering from concomitant injuries and 32% requiring surgical management. While there was a statistically significant difference in mechanism of injury (P=0.026), there was no significant difference in overall incidence, fracture types, incidence of concomitant injuries, or overall proportion requiring surgical intervention during the study period when compared to previous years. Conclusion While some variation in the mechanisms of injury have been observed, the overall incidence, patient, fracture, and injury profiles associated with pelvic and acetabular trauma appear to have remained consistent during the COVID-19 pandemic. Additionally, the number and proportion of those requiring surgical treatment of these fractures have remained stable. Understanding the continued burden of these potentially severe injuries may help guide injury prevention, treatment, and resource allocation as the pandemic continues.
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Affiliation(s)
- Kunal Mohan
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Patrick McCabe
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Wafi Mohammed
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Justin M Hintze
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Hasnain Raza
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Brendan O'Daly
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
| | - Michael Leonard
- Department of Trauma & Orthopaedics, National Centre for Pelvic and Acetabular Surgery, Tallaght University Hospital, Dublin, IRL
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Kurihara H. Emergency surgery and trauma during COVID-19 pandemic: safe, smart and kind! Eur J Trauma Emerg Surg 2021; 47:619-620. [PMID: 34100964 PMCID: PMC8186015 DOI: 10.1007/s00068-021-01682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hayato Kurihara
- Emergency Surgery and Trauma Unit, IRCCS, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Italy.
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Lazzati A, Raphael Rousseau M, Bartier S, Dabi Y, Challine A, Haddad B, Herta N, Souied E, Ortala M, Epaud S, Masson M, Salaün-Penquer N, Coste A, Jung C. Impact of COVID-19 on surgical emergencies: nationwide analysis. BJS Open 2021; 5:6280342. [PMID: 34021327 PMCID: PMC8140197 DOI: 10.1093/bjsopen/zrab039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. Methods This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. Results During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). Conclusion A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.
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Affiliation(s)
- A Lazzati
- Department of General and Digestive Surgery, Intercommunal Hospital of Créteil, Créteil, France.,INSERM U955, IMRB, Créteil, France
| | - M Raphael Rousseau
- Department of Medical Informatics, Intercommunal Hospital of Créteil, Créteil, France
| | - S Bartier
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - Y Dabi
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - A Challine
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, AP-HP, Université de Paris, Cochin Hospital, France
| | - B Haddad
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - N Herta
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | - E Souied
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | | | - S Epaud
- Kaduceo SAS, Toulouse, France
| | | | | | - A Coste
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - C Jung
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
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Ruiz-Medina PE, Ramos-Meléndez EO, Cruz-De La Rosa KX, Arrieta-Alicea A, Guerrios-Rivera L, Nieves-Plaza M, Rodríguez-Ortiz P. The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico. Inj Epidemiol 2021; 8:22. [PMID: 33752760 PMCID: PMC7982880 DOI: 10.1186/s40621-021-00324-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital. Methods An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05. Results A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS. Conclusions Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.
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Affiliation(s)
- Pedro E Ruiz-Medina
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA. .,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA. .,, San Juan, USA.
| | - Ediel O Ramos-Meléndez
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | - Kerwin X Cruz-De La Rosa
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | | | | | - Mariely Nieves-Plaza
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | - Pablo Rodríguez-Ortiz
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
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McGraw C, Salottolo K, Carrick M, Lieser M, Madayag R, Berg G, Banton K, Hamilton D, Bar-Or D. Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers. Inj Epidemiol 2021; 8:24. [PMID: 33752758 PMCID: PMC7983106 DOI: 10.1186/s40621-021-00322-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.
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Affiliation(s)
- Constance McGraw
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Kristin Salottolo
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA
| | - Matthew Carrick
- Trauma Services Department, Medical City Plano, Plano, TX, USA
| | - Mark Lieser
- Trauma Services Department, Research Medical Center, Kansas City, MO, USA
| | - Robert Madayag
- Trauma Services Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Services Department, Wesley Medical Center, Wichita, KS, USA
| | - Kaysie Banton
- Trauma Services Department, Swedish Medical Center, Englewood, CO, USA
| | - David Hamilton
- Trauma Services Department, Penrose-St. Francis Health Services, Colorado Springs, CO, USA
| | - David Bar-Or
- Trauma Research Department, Injury Outcomes Network, Englewood, CO, USA.
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Bhat AK, Vijayan S, Acharya AM, Shetty S, Ampar N, Kanhangad MP, Hegde N. Operation theatre protocol for COVID-19 cases requiring orthopaedic surgery: A workflow without altering the existing infrastructure. J Clin Orthop Trauma 2021; 17:163-168. [PMID: 33776361 PMCID: PMC7979274 DOI: 10.1016/j.jcot.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The surge in the number of trauma cases following relaxation of lockdowns in the backdrop of COVID-19 pandemic, has strained the existing infrastructure to cater to these patients and also prevent the spread of infection. Moreover, with the rise of newer strains, the period ahead has to be tread carefully to prevent resurgence of infections. There have been recommendations regarding the ideal setup to operate orthopaedic cases in this pandemic scenario. However, many of the hospitals in India with financial and logistic constraints are unable to implement these structural changes into their existing setup. We propose a model which can be used in an existing operation theatre which has a single entry and exit corridor, which is the layout in many hospitals. METHODOLOGY A protocol with the consultation of a panel of health care professionals was designed on the basis of WHO guidelines in a way so as to remain dynamic. Prior to its implementation, online classes were conducted and a dry run of the protocol was done with the whole team involved. The theatre layout is one with a single entry and exit and had predesignated rooms. The personnel were divided into 3 teams, each with a fixed set of people and preset workflow, to be followed during entry and exit. Five COVID positive cases have been operated since then using the protocol and has been used as a pilot study to further amend the protocol. CONCLUSION This model can be used as a guideline by hospitals having a limited infrastructure, to develop their own protocol to operate on COVID positive cases, in the present situation of increasing trauma cases post the relaxation of lockdown and also in any subsequent waves of infection with newer strains. Simulation and periodic stringent audits with the entire team would prove successful in rectifying errors and avoiding any possible contamination.
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Affiliation(s)
- Anil K. Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sandeep Vijayan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ashwath M. Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sourab Shetty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India,Corresponding author.
| | - Nishanth Ampar
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Madhava Pai Kanhangad
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nikhil Hegde
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, Hawton K, O'Connor RC, Kapur N, Moran P, O'Neill S, McGuiness LA, Olorisade BK, Dekel D, Macleod-Hall C, Cheng HY, Higgins JP, Gunnell D. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review. F1000Res 2020; 9:1097. [PMID: 33604025 PMCID: PMC7871358 DOI: 10.12688/f1000research.25522.1] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The COVID-19 pandemic has caused morbidity and mortality, as well as, widespread disruption to people's lives and livelihoods around the world. Given the health and economic threats posed by the pandemic to the global community, there are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review (LSR) focuses on suicide prevention in relation to COVID-19, with this iteration synthesising relevant evidence up to June 7 th 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. Results: Searches identified 2070 articles, 29 (28 studies) met our inclusion criteria, of which 14 articles were research letters or pre-prints awaiting peer review. All articles reported observational data: 12 cross-sectional; eight case series; five modelling; and three service utilisation studies. No studies reported on changes in rates of suicidal behaviour. Case series were largely drawn from news reporting in low/middle income countries and factors associated with suicide included fear of infection, social isolation and economic concerns. Conclusions: A marked improvement in the quality of design, methods, and reporting in future studies is needed. There is thus far no clear evidence of an increase in suicide, self-harm, suicidal behaviour, or suicidal thoughts associated with the pandemic. However, suicide data are challenging to collect in real time and economic effects are evolving. Our LSR will provide a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide. PROSPERO registration: CRD42020183326 01/05/2020.
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Affiliation(s)
- Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Chukwudi Okolie
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Keith Hawton
- University Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rory C. O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Luke A. McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dana Dekel
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
| | | | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P.T. Higgins
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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42
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John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, Hawton K, O'Connor RC, Kapur N, Moran P, O'Neill S, McGuiness LA, Olorisade BK, Dekel D, Macleod-Hall C, Cheng HY, Higgins JP, Gunnell D. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review. F1000Res 2020; 9:1097. [PMID: 33604025 PMCID: PMC7871358 DOI: 10.12688/f1000research.25522.2] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people's lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.
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Affiliation(s)
- Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Chukwudi Okolie
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Keith Hawton
- University Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rory C. O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Luke A. McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dana Dekel
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
| | | | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P.T. Higgins
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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