The hidden dangers of staying home: a London trauma unit experience of lockdown during the COVID-19 virus pandemic

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

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.

Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa

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.

Characterization of Traumatic Injury During the Early COVID-19 Pandemic: Results From a National Healthcare Database

OBJECTIVE

To characterize traumatic injury patterns after stay-at-home orders were implemented in the United States in response to the coronavirus disease 2019 (COVID-19).

METHODS

A retrospective review of a convenience sample of patients from a national healthcare research database (TriNetX) was conducted from April 1, 2020, to June 30, 2020. Inclusion criteria included all patients with documentation of both injury pattern and mechanism of injury. A comparison was made to a matched pre-pandemic timeframe. Changes in percentage and rate ratio (RR) with a 95% confidence interval were reported. RRs were calculated using Poisson regression analysis.

RESULTS

 A total of 238,661 patients in the control and 178,224 patients in the study cohorts were analyzed. Significant increases in assaults (RR: 1.17, 95% CI: 1.14, 1.20) and bicycle accidents (RR: 1.07, 95% CI: 1.04, 1.11) were noted. There was a relative increase in patients who were male (+1.78%) and white (+2.01%). More injuries were alcohol-related (+0.76%) and occurred at home (+0.79%). A decrease in motor vehicle accidents (-1.17%), foot and ankle injuries (-1.63%), and injuries occurring at sporting events (-0.54%) was noted.

CONCLUSIONS

Changes in injury patterns were observed during the study period. During future crises, particular public health and injury prevention resources may be required to address assaults, substance abuse, and home safety.

The 1 Year Effect of COVID-19 on Plastic Surgery Trauma at a Level One Trauma Centre: A Retrospective Review

Introduction: Since the onset of the COVID-19 pandemic, Canada has seen significant societal and health changes leading to the closures of many businesses and shifts in the daily activities of many Canadians. Despite these changes and a sharp drop in the number of patients attending emergency departments across British Columbia (BC), little change was noted in the use of protected plastic surgery trauma time at a level one trauma centre surveyed in BC. The purpose of this study was to analyze and compare the changes in plastic surgery-related trauma cases before and after the onset of the COVID-19 pandemic, both in etiology and case description. Methods: A retrospective medical chart review was performed, evaluating all of the participating surgeon's trauma slates in the year before and after April 1, 2020. Patient demographics, etiology, injury location, diagnosis, and surgical timing were all recorded and analyzed using an interrupted time-series statistical model. Results: No significant difference was observed in any of the recorded categories across the 2 time periods. Slight increases were noted in workplace injuries, assaults, and home-related machinery injuries. Conclusion: The lack of significant change in workplace injuries likely stemmed from the high number of factories and industrial plants present in our health region, as these jobs lacked the ability to work from home. The results of this study show that the demand for trauma-related plastic surgery care is independent of an overall decrease in hospital admissions and therefore should be planned and budgeted for accordingly.