COVID-19 outbreak impact on emergency trauma visits and trauma surgery in a level 3 trauma center

Prevalence, Predictors and Reasons for Discharge Against Medical Advice Among Patients With Chronic Disease During COVID-19

BACKGROUND

Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: (1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, (2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, (3) the predictors of DAMA and (4) the reasons behind DAMA at the patient, hospital and environmental levels.

METHODS

A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals.

RESULTS

The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital and environmental-related factors had a low impact on DAMA.

CONCLUSIONS

DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study's findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.

Effect of the COVID‑19 pandemic on the management and outcomes of patients with traumatic injuries (Review)

During the COVID-19 pandemic, ~10% of the global population was officially affected, resulting in diverse changes, ranging from shopping habits to stringent hospital protocols. This article sought to provide a concise summary of relevant data concerning the interplay between COVID-19 and trauma, encompassing the entire trajectory from presentation to hospital discharge. Throughout the pandemic, there was a noticeable reduction in trauma presentations, while the ranking of injury mechanisms remained largely unchanged. To ensure essential surgical support, protocols were adjusted accordingly. Although there were some less significant changes in injury severity score, hospital length of stay, intensive care unit stay and mortality, the overall patient outcomes appeared to improve. In conclusion, the COVID-19 pandemic led to a decline in trauma cases and an enhancement in patient outcomes. However, regrettably, certain mechanisms of injury saw an increase in frequency. To cope with the epidemiological context, management strategies were adapted, and unutilized resources were redirected to cater to the care of COVID-19 patients.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a major and costly public health emergency.

AIM

To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.

METHODS

All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled. We collected data on demographics, daily visits, injury type, injury mechanism, injury severity score, and patient management for comparative analysis.

RESULTS

The total number of patients in the trauma center of our hospital decreased by 50.38% during the COVID-19 Lockdown in 2020 compared to the same period in 2019. The average number of trauma visits per day in 2019 was 47.94, compared to 23.79 in 2020. Comparing the patients’ demographic data, loss of employment was the most predominate characteristic in 2020 compared to 2019, while there was no significant difference in gender, age, and marital status between both periods. During the lockdown period, the proportion of traffic accident-related injuries, injuries due to falls greater than 1.5 m, and mechanical injuries decreased significantly, whereas the proportion of injuries caused by falls less than 1.5 m, cuts, assault, bites, and suicidal tendencies and other injuries increased relatively. In addition, the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown. The hospitalization rate increased significantly, and there was no significant difference in emergency surgery and death rates.

CONCLUSION

The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital, which can be monitored regularly. Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries. Emergency surgery and mortality rates remain high, increased because of factors such as family injury and penetrating injury, and hospitalization rates have increased significantly. Therefore, our trauma center still needs to be fully staffed. Finally, from the perspective of the injury mechanism, indoor trauma is a major risk during a lockdown, and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Comparative analysis of the trauma care profile before and during the COVID-19 pandemic: a cross-sectional study in a tertiary university hospital

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.

COVID-19 hastalarında varyantların ve aşıların prognoza etkisi: Retrospektif gözlemsel çalışma

Aim: The effect of novel coronavirus disease 2019 (COVID-19) vaccines on variants of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is unclear. In this study, we aimed to investigate the prognostic effect of variants and vaccines in hospitalized COVID-19 patients. Materials and Methods: This retrospective study was conducted in 588 hospitalized patients with COVID-19 between May 1st, 2021 and August 31st, 2021. The patients were divided into groups according to variant analysis and demographic characteristics, laboratory data, vaccination status and in-hospital mortality rates were compared. Results: Variants (Alpha [B.1.1.7], Beta [B.1.351], Delta [B.1.617.2]) were detected in 46.3% of the patients. The intensive care unit (ICU) admission rate was 46.8% and the in-hospital mortality rate was 33.3%. There was no statistically significant difference between the patients with variant detection and those without variant detection in terms of ICU admission and in-hospital mortality. The rate of unvaccinated patients was 63.6%. The in-hospital mortality rate was similar in those vaccinated with two doses of CoronaVaC (37.1%) to that in the unvaccinated (32.9%), but higher than in those vaccinated with two doses of BNT162B2 (16.7%). Conclusion: There was no increase in the mortality rates in hospitalized patients with variants compared to those without. The mortality rate in those vaccinated with two doses of CoronaVaC was similar to that in those not vaccinated.