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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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Meisgeier A, Pienkohs S, Moosdorf L, Neff A. Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database. Oral Maxillofac Surg 2024:10.1007/s10006-024-01248-9. [PMID: 38600413 DOI: 10.1007/s10006-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. RESULTS A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). CONCLUSIONS During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. TRIAL REGISTRATION German Clinical Trials Register No: DRKS00032778.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
| | - Laura Moosdorf
- Center for Orthopaedics and Trauma Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
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Decker SL, Zuvekas SH. A Nationally Representative Summary of 2020 Changes in the Use of Health Care in the United States. J Ambul Care Manage 2024; 47:64-83. [PMID: 38345888 DOI: 10.1097/jac.0000000000000488] [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: 03/06/2024]
Abstract
The COVID-19 pandemic produced an unprecedented shock to the U.S. health care system. Prior literature documenting 2020 changes has been limited to certain types of care or subsets of patients. We use the nationally representative Medical Expenditure Panel Survey to summarize changes in all types of health care from 2018 through 2020. Outpatient visits, emergency department visits, and inpatient admissions each fell about 35% in April 2020. Dental visits fell over 80%. Ophthalmology visits declined 71% and mammograms 82%. Psychiatric visits rose slightly (1.6%). By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than 2019.
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Affiliation(s)
- Sandra L Decker
- Author Affiliations: U.S. Agency for Healthcare Research and Quality, Rockville, MD (Drs Decker and Zuvekas)
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Maganti N, Huang L, Banghart M, Channa R, Chang JS, van Landingham SW. Ocular Emergencies During the Coronavirus Disease 'Safer at Home Order' in Wisconsin. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2023; 122:331-336. [PMID: 38180919 PMCID: PMC10947423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
INTRODUCTION The coronavirus pandemic created large shifts in utilization of hospital resources, patient presentations, and delivery of medical care. OBJECTIVES This retrospective study evaluated the ocular emergencies at a tertiary-care academic hospital in Wisconsin during the COVID-19-related "Safer at Home" order. METHODS Ophthalmology consultations performed March 23 through May 26, 2020, were compared to the same time period in the 4 preceding years and the subsequent year. Billing codes were obtained to evaluate the diagnoses and procedures performed during this time frame. RESULTS In 2020, 155 consultations were performed (42 emergency department, 113 inpatient), compared to a mean of 214 over the 5 other study years. The incidence rate ratio (IRR) of total consultations in 2020 was 0.72 (P ≤ 0.001) compared to previous years. Significantly fewer emergency department consultations were performed (IRR 0.62, P ≤ 0.001), while inpatient consultations were similar (IRR 0.88, P = 0.119). The most common diagnosis across all study years was fracture of the skull/orbit with injury to the eye/orbit. In 2020, 13% of consultations led to a procedure, compared to a total of 16% in the other years (IRR 0.59, P = 0.018). CONCLUSIONS This study demonstrated a 28% reduction in ophthalmology consultations at a major university hospital in Wisconsin during the COVID-19-related "Safer at Home" order, though the number of consultations leading to surgery were stable. This suggests that while patients with less acute needs may have deferred care, those requiring urgent surgery still presented to the emergency department. These data may help hospitals appropriately allocate eye care resources during future public health emergencies.
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Affiliation(s)
- Nenita Maganti
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health,, Madison, Wisconsin
| | - Leslie Huang
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark Banghart
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suzanne W van Landingham
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
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Mayr R, Iltchev A, Bonatti A, Forstner B, Fritz J, Gassner E, Arora R. [Trauma emergency room cases before and during the COVID-19 pandemic : Data from an alpine trauma center]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:960-966. [PMID: 36534361 PMCID: PMC9761024 DOI: 10.1007/s00113-022-01268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The COVID-19 pandemic had a strong impact on the work of trauma medical teams. The aim of the study was to compare the trauma emergency room (TER) incidence and trauma mechanisms before and during the pandemic at a level I trauma center. OBJECTIVE The TER incidence before and during the pandemic should be assessed to be prepared for future pandemics or new COVID-19 outbreaks. MATERIAL AND METHODS Medical charts from all TER patients from March 2019 to February 2021 were analyzed. The incidence and trauma mechanisms of the 12 months before and the 12 months during the pandemic were compared. The trauma distribution and severity were described by the AIS and ISS, and the patients' country of residency was noted. RESULTS The TER cases decreased from 694 before the COVID-19 pandemic to 477 cases during the pandemic (Incidence rate 0.69). The strongest decrease in trauma cases was noted in sports injuries (0.55), followed by suicide attempts (0.63), traffic accidents (0.71) and leisure accidents (0.76). The rate of patients with severe injuries (ISS ≥ 16) was comparable with 40% before the pandemic and 44% during the pandemic. Foreign residency of TER patients shifted from 37% before the pandemic to 16% during the pandemic. The number of foreign patients was significantly reduced during the pandemic (257 vs. 77). DISCUSSION The TER incidence significantly decreased during the pandemic due to the imposed lockdowns during the peak winter tourism season. The rate of foreign TER patients changed during the pandemic, while the rate of severely injured patients remained stable.
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Affiliation(s)
- R Mayr
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - A Iltchev
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - A Bonatti
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - B Forstner
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - J Fritz
- Department für Medizinische Statistik, Informatik und Gesundheitsökonomie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - E Gassner
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - R Arora
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
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Kabiri N, Abbasi A, Pashazadeh F, Hajebrahimi S, Soleimanpour H. The Impact of The COVID-19 Pandemic on Hospital Admissions Due to Road Traffic Crashes; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e12. [PMID: 38162384 PMCID: PMC10757575 DOI: 10.22037/aaem.v12i1.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Introduction During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes. Methods This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The meta-analysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes. Results A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p<0.00001]. The heterogeneity assessment of the included studies in the meta-analysis showed high heterogeneity (I2=78%, p<0.00001). Conclusion The results of this systematic review showed that the COVID-19 pandemic dramatically reduced the number of hospital admissions related to road traffic crashes because of both quarantines and lifestyle changes. Health policymakers and top health managers might use the results of this systematic review in similar contexts in the future.
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Affiliation(s)
- Neda Kabiri
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Abbasi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Urology Department, Helsinki University, Helsinki, Finland
| | - Hassan Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Roskam JS, Hauser KM, DiFazio LT, Rolandelli RH, Nemecz AK, Nemeth ZH. COVID-19 Pandemic Effects on Clinical Outcomes of Hip Fractures Among Pediatric and Adult Patients. J Trauma Nurs 2023; 30:334-339. [PMID: 37937874 DOI: 10.1097/jtn.0000000000000752] [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: 11/09/2023]
Abstract
BACKGROUND Little is known about the distribution and outcomes of hip fractures in pediatric patients during the COVID-19 pandemic. OBJECTIVE To study the clinical outcomes of both pediatric and adult patients who underwent hip fracture surgeries and determine the effects of changes surrounding the COVID-19 pandemic. METHODS Both pediatric and adult surgical hip fracture cases were analyzed from the pandemic year (2020) and the control year (2019) using the American College of Surgeons National Surgical Quality Improvement Program database. RESULTS Between the prepandemic (control) and pandemic years, a total of 2,438 pediatric and 28,180 adult cases were compared. Pediatric patients had similar perioperative characteristics and outcomes between the two years. Significantly fewer hip fractures were reported among adults during the pandemic (p < .001). Preoperatively, more adult patients had ventilator dependence (p = .020), transfusions (p = .029), and systemic inflammatory response syndrome (p < .001) in 2020. Adult operations were more likely to be emergent in 2020 (p < .001) and adults had more severe disease states. Length of stay (p < .001) and the time from operation to discharge (p < .001) were significantly longer for the adult cohort in 2020. Mortality was also higher for adults during the first year of the pandemic (p = .003), and superficial surgical site infections became more common (p = .036). CONCLUSION Pediatric hip fracture patients had similar clinical outcomes between 2019 and 2020. Adults with hip fractures presented in more serious clinical conditions, which resulted in higher mortality in 2020. Further studies could better clarify the reasons as to why adult hip fracture patients had markedly worse clinical course during the COVID year than pediatric patients.
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Affiliation(s)
- Justin S Roskam
- Department of Surgery, Morristown Medical Center, Morristown, New Jersey (Messrs Roskam and Hauser and Drs DiFazio, Rolandelli, Nemecz, and Nemeth); and Department of Anesthesiology, Columbia University, New York, New York (Dr Nemeth)
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Sethuraman U, Kannikeswaran N, Singer A, Krouse CB, Cloutier D, Farooqi A, Donoghue L, Stankovic C. Trauma Visits to a Pediatric Emergency Department During the COVID-19 Quarantine and "Stay at Home" Period. Am Surg 2023; 89:4262-4270. [PMID: 34784788 DOI: 10.1177/00031348211047497] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impact of social distancing on pediatric injuries is unknown. METHODS We retrospectively compared injury visits to a pediatric emergency department by individuals ≤21 years during "Stay at Home" (SHO) period to the same period in 2019 (non-SHO). Demographics, types, and outcomes of injuries were noted. RESULTS Although, there was a 35.6% reduction in trauma-related emergency department visits during SHO period (1226 vs 1904), the proportion of injury visits increased (15.5% vs 8.1%, P < .001) and mean age was lower (5.8 yrs ±4.5 vs 8.4 yrs ± 5.2, P < .001). There were significant increases in visits related to child physical abuse (CPA), firearms, and dog bites. Further, significant increases in trauma alerts (P < .01), injury severity (P < .01), critical care admissions (P < .001), and deaths (P < .01) occurred during the SHO period. CONCLUSIONS Although overall trauma-related visits decreased during SHO, the proportion of these visits and their severity increased. Trauma visits related to child physical abuse, dog bites, and firearms increased. Further studies are required to assess the long-term impact of pandemic on pediatric trauma epidemiology.
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Affiliation(s)
- Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
| | - Adam Singer
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
| | | | - Dawn Cloutier
- Children's Hospital of Michigan, Trauma Program, MI, USA
| | - Ahmad Farooqi
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
| | - Lydia Donoghue
- Children's Hospital of Michigan, Trauma Program, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Curt Stankovic
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA
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Motilal S, Khan R, St Bernard G, Ivey MA, Reid SD. Positive influences of the COVID-19 pandemic on community dwelling adults in Trinidad and Tobago: a cross sectional study. J Ment Health 2023; 32:869-878. [PMID: 36083113 DOI: 10.1080/09638237.2022.2118690] [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: 06/02/2021] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. AIMS To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. METHOD A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. RESULTS Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. CONCLUSIONS Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.
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Affiliation(s)
- Shastri Motilal
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Raveed Khan
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Godfrey St Bernard
- Sir Arthur Lewis Institute of Social and Economic Studies, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Marsha A Ivey
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Sandra D Reid
- Psychiatry Unit, Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
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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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Al Harthi R, Al Hinai M, Al Abri M, AlMaamari A, Stephen E, Al Qadhi H. The Impact of the COVID-19 Pandemic on the Pattern of Trauma Presenting to a Tertiary Care Trauma Centre in Oman. Sultan Qaboos Univ Med J 2023; 23:297-302. [PMID: 37655093 PMCID: PMC10467548 DOI: 10.18295/squmj.12.2022.065] [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: 02/09/2022] [Revised: 06/23/2022] [Accepted: 10/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to investigate the change in the pattern of the presentation of trauma cases at the Sultan Qaboos University Hospital, before the COVID-19 pandemic and during its two waves/phases. Methods This retrospective study was carried out from January 2019 to October 2021. Data on all trauma patients were collected from the hospital information system after ethics committee approval. The pattern of trauma was divided into paediatric, adult and geriatric age groups. The location of trauma was described as either outdoors, at home or on roads. This information was collected along with the details of the mechanism of trauma. Patients with incomplete data were excluded. Results Based on the inclusion criteria, 589 records were analysed. The mean age of presentation was 29 years. The majority were male (71%) with 54.2% adults, 34% paediatrics and 11.9% geriatrics. There was a gradual increase in the percentage of paediatric trauma during pre-COVID, COVID phase one and phase two, which were 29%, 32% and 51%, respectively. A significant decline (almost 50%) in the number of geriatric trauma cases was observed between pre-COVID and COVID phase two. Trauma at home increased by 65.9% during COVID phase two and penetrating trauma increased by 16.5% during COVID phase two. Intensive care unit admissions increased during the first phase of the pandemic by 10.5%. Conclusion A significant change was found in the pattern of trauma cases before and during the COVID-19 pandemic. These observations could lead to better safety guidelines for the paediatric age group and steps could be taken to reduce penetrating trauma.
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Affiliation(s)
- Rahma Al Harthi
- Department of General Surgery, Oman Medical Specialty Board, Muscat, Oman
| | - Maram Al Hinai
- Department of General Surgery, Oman Medical Specialty Board, Muscat, Oman
| | - Maather Al Abri
- Department of General Surgery, Sultan Qaboos University, Muscat, Oman
| | | | - Edwin Stephen
- Department of General Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Hani Al Qadhi
- Department of General Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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12
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Tefera A, Lutge EE, Moodley N, Xaba XW, Hardcastle TC, Brysiewicz P, Clarke DL. Tracking the Trauma Epidemic in KwaZulu-Natal, South Africa. World J Surg 2023; 47:1940-1945. [PMID: 37160653 PMCID: PMC10310579 DOI: 10.1007/s00268-023-07032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Trauma remains an important cause of morbidity and mortality in South Africa, but attempts to track the epidemic are often based on mortality data, or derived from individual health facilities. This project is based on the routine collection of trauma data from all public health facilities in the province of KwaZulu-Natal (KZN), between 2012 and 2022. METHODS Hospital level data on trauma over the past ten years was drawn from the district health information system (DHIS). Data relating to assaults, gunshots and motor vehicle collisions (MVCs) were recorded in the emergency rooms, whilst data on admissions are recorded in the wards and intensive care units. RESULTS There were 1,263,847 emergency room visits for assaults, gunshots and MVCs over the ten-year period and trauma admissions ranged between four and five percent of the total number of hospital admissions annually. There was a dramatic decrease in trauma presentations and admissions over 2020/2021 as a result of the COVID lockdowns. Over the entire period, intentional injury was roughly twice as frequent as non-intentional injury. Intentional trauma had an almost equal ratio of blunt assault to penetrating assault. Gunshot-related assault increased dramatically over the 2021/2022 collecting period. CONCLUSIONS The burden of trauma in KZN remains high. The unique feature of this burden is the excessively high rate of intentional trauma in the form of both blunt and penetrating mechanisms. Developing injury-prevention strategies to reduce the burden of interpersonal violence is more difficult than for unintentional trauma.
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Affiliation(s)
- Aida Tefera
- Health Services Planning, Delivery, Monitoring and Evaluation Component, KZN Department of Health, Durban, South Africa
| | - Elizabeth Eleanor Lutge
- Health Services Planning, Delivery, Monitoring and Evaluation Component, KZN Department of Health, Durban, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Nirvasha Moodley
- Health Services Planning, Delivery, Monitoring and Evaluation Component, KZN Department of Health, Durban, South Africa
| | - Xolani Wiseman Xaba
- Health Services Planning, Delivery, Monitoring and Evaluation Component, KZN Department of Health, Durban, South Africa
| | - Timothy Craig Hardcastle
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, KZN Department of Health, Durban, South Africa
| | - Petra Brysiewicz
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Damian Luiz Clarke
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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A G, D W, H K C, S W, N H, R H, I U, S C. Changes in adult trauma at a level 1 trauma center before and during the COVID-19 pandemic. JEM REPORTS 2023; 2:100024. [PMID: 37124345 PMCID: PMC10122564 DOI: 10.1016/j.jemrpt.2023.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 05/02/2023]
Abstract
Background Prior research has shown the COVID-19 pandemic is associated with changes in ED volumes, trauma caseloads and distribution of disease. Objectives We aim to characterize the impact of the COVID-19 pandemic at a diverse, high-volume Level 1 trauma center in the US. Methods We performed a retrospective review of our institutional trauma registry at our center from 2018 through 2021 to study changes before and after COVID-19. We established March 14 - December 31 as the study period of interest for each year. We analyzed the data with descriptive statistics and created Poisson regression models to determine the estimated percentage year-to-year changes. Results Total number of trauma cases increased with each subsequent year from 2018 (N = 4605) to 2021 (N = 7331) (total N = 23,727). In general, the proportion of Black or African American patients increased over time (2018: 19.2%, 2021: 23.0%). The proportion of patients insured by Medicaid (8.0% vs 10.5%) and Medicare (26.5% vs 32.8%) increased from 2018 to 2021. Comparing 2019 to 2020, we found increases in violent traumas: GSW (+88.6%, 95% CI 63.8%-117.2%) and stabbings (+39.6%, 95% CI 8.1%-80.3%). Trauma patient ED LOS decreased from 300 min (67-400 IQR) in 2018 to 249 min in 2021 (104-510 IQR). Conclusion This analysis identified increased trauma volumes, especially violent trauma (GSW, stabbing, other penetrating). There was a greater proportion of Black/African American patients and those insured with Medicare or Medicaid during the pandemic. TED LOS decreased over time while ED mortality and hospital LOS remained stable.
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Affiliation(s)
- Garcia A
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Walter D
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Chan H K
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Walia S
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hoot N
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Huebinger R
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Ugalde I
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Chavez S
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
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14
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Karimov Z, Ozgiray E. The Effect of COVID-19 in a University Hospital Neurosurgery Clinic Comparison to Prepandemic Period: A Retrospective Study with 6 months of Data. World Neurosurg 2023; 173:e616-e621. [PMID: 36870446 PMCID: PMC9981517 DOI: 10.1016/j.wneu.2023.02.114] [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: 11/11/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic affected all countries' health systems and people's lifestyles. In this study, we aimed to investigate its effects in a university hospital neurosurgery clinic. METHODS The 2019 year's 6 months' data as a prepandemic period compared to the 2020 year's same period as a pandemic date. Demographic data were collected. Operations were divided into seven groups: tumor, spinal, vascular, cerebrospinal fluid disorders, hematoma, local, and minor surgery, respectively. We classified the hematoma cluster into subgroups to evaluate the etiology: epidural, acute subdural, subarachnoid hemorrhage, intracerebral hemorrhage, depressed skull fractures, and others. Patients' COVID-19 test results were collected. RESULTS Total operations decreased from 972 to 795 (Δ18.2%) during the pandemic. All groups, except minor surgery cases, decreased compared to the prepandemic period. Also, vascular procedures for females increased during the pandemic period. While focusing on the hematoma subgroups, there was decreasing in epidural and subdural hematomas, depressed skull fractures, and total case numbers; an increase in subarachnoid hemorrhage and intracerebral hemorrhage. Overall mortality significantly increased to 9.6% from 6.8% during the pandemic (P = 0.033). Eight (1.0%) of 795 patients were COVID-19-positive; three of them died. Neurosurgery residents and academicians were unsatisfied with decreased number of operations, training, and research productivity. CONCLUSIONS The pandemic and restrictions affected negatively the health system and people's access to healthcare. Our retrospective observational study aimed to evaluate these effects and take lessons for the next similar situations. People's access to health care should be considered when lockdown restrictions.
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Affiliation(s)
- Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkiye.
| | - Erkin Ozgiray
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkiye
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15
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Coşkun M, Çilengir AH, Çetinoğlu K, Horoz M, Sinci A, Demircan B, Uluç E, Gelal F. Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans. Diagn Interv Radiol 2023; 29:373-378. [PMID: 36988026 PMCID: PMC10679709 DOI: 10.5152/dir.2022.211043] [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: 10/14/2021] [Accepted: 01/28/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic. METHODS Patients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually. RESULTS The total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10-59 age group during the pandemic (P < 0.001). The highest increase was seen in the 20-29 age group, being 18.6 fold. One death was recorded per 58 chest CT scans during the pandemic. Chest CT use was substantially higher at the beginning of the pandemic. CONCLUSION Chest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years.
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Affiliation(s)
- Mehmet Coşkun
- Clinic of Radiology, University of Health Science Turkey, Dr. Behçet Uz Children Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | | | - Kenan Çetinoğlu
- Clinic of Radiology, Merkezefendi State Hospital, Manisa, Turkey
| | - Merve Horoz
- Clinic of Radiology, Çiğli Regional Training and Research Hospital, İzmir, Turkey
| | - Ayberk Sinci
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Betül Demircan
- Clinic of Pediatrics, Bakırçay University Çiğli Regional Training and Research Hospital, İzmir, Turkey
| | - Engin Uluç
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Fazıl Gelal
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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16
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Bashiri A, Morada A, Sultany M, Senepathi S, Silverman S, Casós S, Behm R. Trends of Trauma Admissions in a Rural Trauma Center During Coronavirus Disease 2019 Pandemic. J Surg Res 2023; 289:202-210. [PMID: 37141703 PMCID: PMC10008796 DOI: 10.1016/j.jss.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 01/19/2023] [Accepted: 02/18/2023] [Indexed: 03/18/2023]
Abstract
Introduction The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to implementing strict social distancing mandates nationwide. This study evaluates the trauma trends during the pandemic at a rural level II trauma center in Pennsylvania. Methods A retrospective review of all trauma registries between 2018 to 2021 was performed overall and on a 6-monthly basis. Injury severity score (ISS), injury types – blunt vs. Penetrating – and mechanisms of injury were compared across the years. Results A total of 3,056 patients in 2018-2019, and 2,506 patients in 2020-2021 were evaluated as the historic control and study group, respectively. The median age of the patients was 63 and 62 in the control and the study group respectively (p=0.616). There was an overall significant decline in blunt injuries and an increase in penetrating injuries (Blunt: 2945 vs 2329, Penetrating: 89 vs 159, p<0.001). Injury severity score was not different across the eras. Falls, motorcycle accidents (MCA), motor-vehicle accidents (MVA) and all-terrain vehicles (ATVs) comprised most of the blunt traumas. Penetrating injuries secondary to assault with firearms and sharp weapons had an increasing trend. Conclusion There was no association between trauma numbers and the beginning of the pandemic. Overall, there was a decline in trauma numbers during the second 6 months of the pandemic. There was an increase in injuries involving firearms and stabbing. Rural trauma centers have a unique demographic and admission trend that should be considered while advising regulatory changes during pandemics.
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Affiliation(s)
- Amir Bashiri
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA,Corresponding author: Amir Bashiri, MD, Guthrie Clinic/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA, 18840 6072610918
| | - Anthony Morada
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Mohammad Sultany
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA
| | - Sri Senepathi
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA
| | - Sydney Silverman
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA
| | - Steven Casós
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA
| | - Robert Behm
- Guthrie Robert Packer Hospital, Department of Surgery, Sayre, Pennsylvania, USA
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Beştemir A, Aydın H, Tuncar A. The Impact of the COVID-19 Pandemic on Emergency Surgical Operations in State Hospitals in Turkey: A Retrospective and Descriptive Study. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2023. [DOI: 10.4274/eajem.galenos.2023.68542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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18
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Sheets NW, Fawibe OS, Mahmoud A, Chawla-Kondal B, Ayutyanont N, Plurad DS. Impact of the COVID-19 Pandemic on Trauma Encounters. Am Surg 2023; 89:434-439. [PMID: 34219502 PMCID: PMC8258398 DOI: 10.1177/00031348211029858] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The Coronavirus Disease 2019 pandemic has affected the health care system significantly. We compare 2019 to 2020 to evaluate how trauma encounters has changed during the pandemic. METHODS Retrospective analysis using a large US health care system to compare trauma demographics, volumes, mechanisms of injury, and outcomes. Statistical analysis was used to evaluate for significant differences comparing 2019 to 2020. RESULTS Data was collected from 88 hospitals across 18 states. 169 892 patients were included in the study. There were 6.3% fewer trauma patient encounters in 2020 compared to 2019. Mechanism of injury was significantly different between 2019 and 2020 with less blunt injuries (89.64% vs. 88.39%, P < .001), more burn injuries (1.84% vs. 2.00%, P = .021), and more penetrating injuries (8.58% vs. 9.75%, P < .001). Compared to 2019, patients in 2020 had higher mortality (2.62% vs. 2.88%, P < .001), and longer hospital LOS (3.92 ± 6.90 vs. 4.06 ± 6.56, P < .001). CONCLUSION The COVID-19 pandemic has significantly affected trauma patient demographics, LOS, mechanism of injury, and mortality.
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Affiliation(s)
- Nicholas W. Sheets
- Riverside Community
Hospital, Riverside, CA, USA,Nicholas W. Sheets, MD, MPH, Trauma and
Acute Care Surgery, Riverside Community Hospital, 4445 Magnolia Ave, Riverside,
CA 92325, USA.
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19
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Strassle PD, Kinlaw AC, Ko JS, Quintero SM, Bonilla J, Ponder M, Nápoles AM, Schiro SE. Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis. Inj Epidemiol 2022; 9:33. [PMID: 36414998 PMCID: PMC9680127 DOI: 10.1186/s40621-022-00409-2] [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: 07/15/2022] [Accepted: 11/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex. METHODS We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home). RESULTS There were 70,478 trauma hospitalizations in North Carolina, 2019-2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change = 1.147, 95% CI = 0.634 to 1.662) and 18-44-year-old males (weekly trend change = 1.708, 95% CI = 0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women ≥ 65 years old (weekly trend change = -4.010, 95% CI = -6.166 to -1.855), but returned to pre-pandemic levels within several months. CONCLUSIONS Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18-44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.
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Affiliation(s)
- Paula D. Strassle
- grid.281076.a0000 0004 0533 8369Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Alan C. Kinlaw
- grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC USA ,grid.10698.360000000122483208Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jamie S. Ko
- grid.281076.a0000 0004 0533 8369Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Stephanie M. Quintero
- grid.281076.a0000 0004 0533 8369Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Jackie Bonilla
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Madison Ponder
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Anna María Nápoles
- grid.281076.a0000 0004 0533 8369Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | - Sharon E. Schiro
- grid.10698.360000000122483208Division of General, Acute Care, and Trauma Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Reihanian Z, Noori Roodsari N, Rimaz S, Asadi P, Khoshsima N, Rafiee Zadeh A, Zia Ziabari SM, Eslami-Kenarsari H, Abbaspour E. Traumatic injuries in children during COVID-19 pandemic: a national report from northern Iran. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:188-193. [PMID: 36420100 PMCID: PMC9677227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There are no comprehensive and accurate statistics on epidemiology and clinical features, especially during the COVID-19 period. The present study tries to describe the pediatric traumas in a referral treatment center in northern Iran during the COVID-19 period and to compare the available statistics with the years before pandemics to examine the differences in the epidemiology of this event in our country. METHODS This cross-sectional study was performed on 543 children under 15 years admitted to this hospital due to different types of traumas in the first six months of 2019 (before the COVID-19 pandemic) and the first six months of 2020 (coinciding with the peak of the pandemic). The information was retrospectively collected by reviewing the hospital recorded files and the trauma-specific hospital information system. RESULTS In total, 436 children were referred before the COVID-19 pandemic period and 107 within the pandemic outbreak. The peak age of patients admitted was 2 to 6 years (32.0%) and 70.5% were male. Most of the pointed children had normal weight. The most common mechanism of trauma before and during the COVID-19 pandemic was falling from a height (46.3% versus 42.1%), followed by road accidents (35.6% versus 36.4%). The overall prevalence of penetrating trauma was 6.9% and 9.3%. The most common body sites affected were the head and neck (32.1%) followed by extremities (before the COVID-19 period) and extremities (29.0%) followed by the head and neck (24.3%) (in the COVID-19 period). The overall rates of multiple trauma before and within the pandemic were also 35.6% versus 35.5%. In children aged 12 to 15 years, road accidents were more reported during the COVID-19 pandemic period (68.4% versus 50.9%) and contrarily falling from a height more before the pandemic (25.5% versus 0.0%). In children under two years of age, head and neck trauma was more reported before the COVID-19 period than in the COVID-19 period (55.6% versus 35.5%), while at this age, limb trauma was more common during the COVID-19 period than before (5.6% versus 20.8%) (P = 0.043). In lean children, abdominal and pelvic trauma were mainly seen in the COVID-19 period (28.6% versus 2.6%) (P = 0.035). CONCLUSION Referrals of children from traumatic injuries decreased during the COVID-19 period. However, the main differences in the mechanism of trauma and the type and severity of traumatic injuries to children in this period emphasize the provision of specific guidelines for trauma management in children.
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Affiliation(s)
- Zoheir Reihanian
- Road Trauma Research Center, Department of Neurosurgery, School of Medicine, Guilan University of Medical SciencesRasht, Iran
| | - Nazanin Noori Roodsari
- Clinical Research Development Unit of Poursina Hospital, Department of Emergency Medicine, School of Medicine, Guilan University of Medical SciencesRasht, Iran
| | - Siamak Rimaz
- Guilan Road Trauma Research Center, Guilan University of Medical SciencesRasht, Iran
| | - Payman Asadi
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical SciencesRasht, Iran
| | - Naghmeh Khoshsima
- Department of Neurosurgery, School of Medicine, Guilan University of Medical SciencesRasht, Iran
| | | | - Seyyed Mahdi Zia Ziabari
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical SciencesRasht, Iran
| | - Habib Eslami-Kenarsari
- MSc in Biostatistics, Vice-chancellor for Resaerch and Technology, Guilan University of Medical SciencesRasht, Iran
| | - Elahe Abbaspour
- Guilan Road Trauma Research Center, Guilan University of Medical SciencesRasht, Iran
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21
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Wang X, Du J, Jiang C, Zhang YY, Tian F, Chen Z, Zhang Y, Zhang Y, Yan L, Hao D. Epidemiological characteristics of traumatic spinal cord injuries in a multicenter retrospective study in northwest China, 2017-2020. Front Surg 2022; 9:994536. [PMID: 36299569 PMCID: PMC9589158 DOI: 10.3389/fsurg.2022.994536] [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: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Background Traumatic spinal cord injuries (TSCIs) are worldwide public health problems that are difficult to cure and impose a substantial economic burden on society. There has been a lack of extensive multicenter review of TSCI epidemiology in northwest China during the Corona Virus Disease 2019 (COVID-19) pandemic. Method A multicenter retrospective study of 14 selected hospitals in two provinces in northwest China was conducted on patients admitted for TSCI between 2017 and 2020. Variables assessed included patient demographics, etiology, segmental distribution, treatment, waiting time for treatment, and outcomes. Results The number of patients with TSCI showed an increasing trend from 2017 to 2019, while there were 12.8% fewer patients in 2020 than in 2019. The male-to-female ratio was 3.67:1, and the mean age was 48 ± 14.9 years. The primary cause of TSCI was high falls (38.8%), slip falls/low falls (27.7%), traffic accidents (23.9%), sports (2.6%), and other factors (7.0%). The segmental distribution showed a bimodal pattern, peak segments were C6 and L1 vertebra, L1 (14.7%), T12 (8.2%), and C6 (8.2%) were the most frequently injured segments. In terms of severity, incomplete injury (72.8%) occurred more often than complete injury (27.2%). The American Spinal Injury Association impairment scale of most patients did not convert before and after treatment in the operational group (71.6%) or the conservative group (80.6%). A total of 975 patients (37.2%) from urban and 1,646 patients (62.8%) from rural areas were included; almost all urban residents could rush to get treatment after being injured immediately (<1 h), whereas most rural patients get the treatment needed 4-7 h after injury. The rough annual incidence from 2017 to 2020 is 112.4, 143.4, 152.2, and 132.6 per million people, calculated by the coverage rate of the population of the sampling hospital. Conclusion The incidence of TSCI in northwest China is high and on the rise. However, due to pandemic policy reasons, the incidence of urban residents decreased in 2020. The promotion of online work may be an effective primary prevention measure for traumatic diseases. Also, because of the further distance from the good conditional hospital, rural patients need to spend more time there, and the timely treatment of patients from remote areas should be paid attention to.
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Affiliation(s)
- Xiaohui Wang
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Department of Orthopaedic, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
| | - Jinpeng Du
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Chao Jiang
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Yong-yuan Zhang
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Fang Tian
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Department of Orthopaedic, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
| | - Zhe Chen
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Department of Orthopaedic, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
| | - Yuyang Zhang
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Department of Orthopaedic, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
| | - Ying Zhang
- Orthopaedic Third Ward, Yulin No. 2 Hospital, Yulin, China
| | - Liang Yan
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China,Department of Orthopaedic, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China,Correspondence: Ding-jun Hao
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22
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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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23
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Boscà-Ramon A, Ratnam L, Cavenagh T, Chun JY, Morgan R, Gonsalves M, Das R, Ameli-Renani S, Pavlidis V, Hawthorn B, Ntagiantas N, Mailli L. Impact of site of occlusion in proximal splenic artery embolisation for blunt splenic trauma. CVIR Endovasc 2022; 5:43. [PMID: 35986797 PMCID: PMC9391208 DOI: 10.1186/s42155-022-00315-0] [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: 04/05/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. Materials and methods Retrospective review was performed of PSAE for blunt splenic trauma (2015–2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. Results Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). Conclusion The results support the proposed optimal embolisation location as being between the DPA and GPA.
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24
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Möttönen J, Kuitunen I, Uimonen M, Mattila VM, Paloneva J, Ponkilainen V. Effect of national COVID-19 lockdown on the incidence of muscle, tendon and ligament injuries and related surgical procedures in the working-aged Finnish population. Arch Orthop Trauma Surg 2022; 143:2539-2545. [PMID: 35780198 PMCID: PMC10110679 DOI: 10.1007/s00402-022-04521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures. MATERIALS AND METHODS This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18-34, 35-50 and 51-65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017-2019. RESULTS Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33-0.80), (IRR 0.53, CI 0.31-0.91), (IRR 0.60, CI 0.38-0.95), respectively. An increase in 18-34 years of age group was detected in June (IRR 1.49, CI 1.05-2.13). Lower extremity injuries decreased in 18-34 years of age group in March (IRR 0.62, CI 0.43-0.90) and April (IRR 0.60, CI 0.42-0.87). A decrease on the incidence of surgeries was observed in April for the 35-50 (IRR 0.53, CI 0.29-0.97) and 51-65 years of age groups (IRR 0.58, CI 0.34-0.98). CONCLUSIONS The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland.
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Affiliation(s)
- Julius Möttönen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
| | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
| | - Juha Paloneva
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville Ponkilainen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
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25
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Antonini M, Hinwood M, Paolucci F, Balogh ZJ. The Epidemiology of Major Trauma During the First Wave of COVID-19 Movement Restriction Policies: A Systematic Review and Meta-analysis of Observational Studies. World J Surg 2022; 46:2045-2060. [PMID: 35723706 PMCID: PMC9208248 DOI: 10.1007/s00268-022-06625-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 01/16/2023]
Abstract
Background The objective of this systematic review is to investigate changes in the epidemiology of major trauma presentations during the implementation of movement restriction measures to manage the first wave of the SARS-CoV-2 (COVID-19) pandemic. Methods A systematic search in six databases, as well as a search of grey literature was performed from January 2020 to August 2021. Estimates were pooled using random-effects meta-analysis. The certainty of evidence was rated according to the GRADE approach. The review is reported using both PRISMA guideline and the MOOSE checklist. Results In total, 35 studies involving 36,987 patients were included. The number of major trauma admissions overall decreased during social movement restrictions (−24%; p < 0.01; 95% CI [−0.31; −0.17]). A pooled analysis reported no evidence of a change in the severity of trauma admissions (OR:1.17; 95%CI [0.77, 1.79], I2 = 77%). There was no evidence for a change in mortality during the COVID-19 period (OR:0.94, 95%CI [0.80,1.11], I2 = 53%). There was a statistically significant reduction in motor vehicle trauma (OR:0.70; 95%CI [0.61, 0.81], I2 = 91%) and a statistically significant increase in admissions due to firearms and gunshot wounds (OR:1.34; 95%CI [1.11, 1.61], I2 = 73%) and suicide attempts and self-harm (OR:1.41; 95%CI [1.05, 1.89], I2 = 39%). Conclusions and relevance Although evidence continues to emerge, this systematic review reports some decrease in absolute major trauma volume with unchanged severity and mortality during the first wave of COVID-19 movement restriction policies. Current evidence does not support the reallocation of highly specialised trauma professionals and trauma resources. Registration PROSPERO ID CRD42020224827.
Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06625-7.
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Affiliation(s)
- Marcello Antonini
- School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.,Medical Research Institute, Lookout Road, New Lambton Heights, NSW, 2305, Australia
| | - Francesco Paolucci
- Newcastle Business School, University of Newcastle, Hunter St &, Auckland St, Newcastle, NSW, 2300, Australia.,Department of Sociology and Business Law, University of Bologna, Strada Maggiore 45, 40126, Bologna, Italy
| | - Zsolt J Balogh
- School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia. .,Division of Surgery, John Hunter Hospital, Locked Bag No. 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia.
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26
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Mariathas HH, Hurley O, Anaraki NR, Young C, Patey C, Norman P, Aubrey-Bassler K, Wang PP, Gadag V, Nguyen HV, Etchegary H, McCrate F, Knight JC, Asghari S. A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial. JMIR Res Protoc 2022; 11:e30454. [PMID: 35323121 PMCID: PMC8990381 DOI: 10.2196/30454] [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: 05/16/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient's perspective, this challenge has been described as "patients wait in pain or discomfort for hours before being seen at EDs." To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. OBJECTIVE The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician's initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon's effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. METHODS The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. RESULTS Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon's eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. CONCLUSIONS By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. TRIAL REGISTRATION ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30454.
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Affiliation(s)
- Hensley H Mariathas
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Oliver Hurley
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nahid Rahimipour Anaraki
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christina Young
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher Patey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital, Carbonear, NL, Canada
| | - Kris Aubrey-Bassler
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Peizhong Peter Wang
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Veeresh Gadag
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Holly Etchegary
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Farah McCrate
- Department of Research and Innovation, Eastern Health, St. John's, NL, Canada
| | - John C Knight
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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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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28
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Chaudhari PP, Anderson M, Ourshalimian S, Goodhue C, Sudharshan R, Valadez S, Spurrier R. Epidemiology of pediatric trauma during the coronavirus disease-2019 pandemic. J Pediatr Surg 2022; 57:284-290. [PMID: 34742575 PMCID: PMC8500847 DOI: 10.1016/j.jpedsurg.2021.09.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE We aimed to describe the epidemiology of trauma activations and variations in injury patterns, injury severity, and hospital length-of-stay for injured children in Los Angeles (LA) County during the coronavirus-disease-19 (COVID-19) pandemic. METHODS We conducted a retrospective cross-sectional study of children aged < 18-years evaluated in 15 trauma centers from 2019 to 2020 and entered in the LA County trauma registry. We defined 01/01/2019-03/18/2020 as pre-pandemic and 03/19/2020-12/31/2020 as the pandemic period. Our primary outcome was pediatric trauma activations. We analyzed demographic and clinical data, including types and severity of injuries sustained. We conducted unadjusted bivariate analyzes of injury patterns between periods. Segmented linear regression models were used to test rates (per 100,000 LA County children) of trauma activations pre-pandemic versus the pandemic period. RESULTS We studied 4399 children with trauma activations, 2695 of which occurred pre-pandemic and 1701 in the pandemic period. Motor vehicle collisions, gunshot wounds, and burns increased during the pandemic (all p-values< 0.05), while sports injuries decreased (p < 0.001). Median injury severity scores (p = 0.323) and Glasgow Coma Scales (p = 0.558) did not differ between periods, however mortality (p = 0.023) decreased during the pandemic. Segmented linear regression estimates demonstrated that rates of trauma activations pre-pandemic were similar to the pandemic period (p = 0.384). CONCLUSION Pediatric trauma activations in LA County did not significantly differ during the COVID-19 pandemic, but types and severity of injuries varied between pre-pandemic and pandemic periods. With lockdown restrictions being lifted and novel SARS-CoV-2 variants circulating, our investigation describes this recent epidemiologic phenomenon to aid future preparation for healthcare systems. LEVEL OF EVIDENCE Level III TYPE OF STUDY: Retrospective cross-sectional study.
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Affiliation(s)
- Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail Stop 113, Los Angeles, CA 90027, USA,Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA,Corresponding author at: Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail Stop 113, Los Angeles, CA 90027, USA
| | - Melissa Anderson
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Catherine Goodhue
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Rasika Sudharshan
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Sara Valadez
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Ryan Spurrier
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA,Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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COŞKUN S, ÇİNKA H, BÜYÜKCERAN İ, ŞAHİNER G, YURTBAY A, ERDOĞAN F, PİŞKİN A. An evaluation of orthopaedic trauma patients presenting at the emergency department during lockdown in the COVID-19 pandemic. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1008433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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30
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Al-Sheikh Hassan M, De Vries K, Rutty J. Emergency trauma care during the COVID-19 pandemic: A phenomenological study of nurses’ experiences. Int Emerg Nurs 2022; 61:101147. [PMID: 35184031 PMCID: PMC8801308 DOI: 10.1016/j.ienj.2022.101147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Abstract
Objective This study aimed to explore nurses’ experiences in delivering emergency trauma care during the COVID-19 pandemic at a level I trauma centre in Saudi Arabia. Methods A qualitative, descriptive phenomenological design was utilised, in which face-to-face, unstructured interviews were carried out with emergency and trauma nurses at a level I trauma centre in Saudi Arabia. The study included nine registered emergency and trauma nurses who were interviewed twice from February to April 2021. The collected data were analysed using Colaizzi’s descriptive phenomenological method. Results The analysis of the data revealed an overarching theme that was about the inevitable change on the ground due to the pandemic and two primary themes, each containing two subthemes: 1 dealing with an interrupted path of care; 1.1 experiencing additional complexity; 1.2 encountering extra demands; 2 optimising the path of care; 2.1 modifying the steps; and 2.2 transforming the system. Conclusion The COVID-19 pandemic imposed change on how trauma patients would be handled and treated. Nurses took an active and critical role in creating another form of change, which helped optimise the path of trauma care and accommodate urgent treatment needs of the injured patients.
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31
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Chen SY, Lo HY, Hung SK. What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis. BMC MEDICAL EDUCATION 2021; 21:618. [PMID: 34911503 PMCID: PMC8671601 DOI: 10.1186/s12909-021-03041-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/25/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles. METHODS A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. RESULTS In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field. CONCLUSIONS The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.
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Affiliation(s)
- Shou-Yen Chen
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences; Division of Medical Education, College of Medicine, Chang Gung University, 333, Taoyuan City, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan
| | - Shang-Kai Hung
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan.
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Choi W, Kim H, Son WS, Sakong S, Cho JM, Choi NJ, Noh TW, Kim N, Cho JW, Oh JK. The Impact of Coronavirus Disease 2019 on Trauma Patients and Orthopedic Trauma Operations at a Single Focused Training Center for Trauma in South Korea. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Huang GS, Chance EA, Dunham CM. Influence of a Stay-At-Home Order on Trauma Volume and Injury Patterns at a Level I Trauma Center in Ohio. Am Surg 2021:31348211047488. [PMID: 34732068 DOI: 10.1177/00031348211047488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Changes in injury patterns during the COVID pandemic have been reported in other states. The objective was to explore changes to trauma service volume and admission characteristics at a trauma center in northeast Ohio during a stay-at-home order (SAHO) and compare the 2020 data to historic trauma census data. METHODS Retrospective chart review of adult trauma patients admitted to a level I trauma center in northeast Ohio. Trauma admissions from January 21 to July 21, 2020 (COVID period) were compared to date-matched cohorts of trauma admissions from 2018 to 2019 (historic period). The COVID period was further categorized as pre-SAHO, active-SAHO, and post-SAHO. RESULTS The SAHO was associated with a reduction in trauma center admissions that increased after the SAHO (P = .0033). Only outdoor recreational vehicle (ORV) injuries (P = .0221) and self-inflicted hanging (P = .0028) mechanisms were increased during the COVID period and had substantial effect sizes. Glasgow Coma Scores were lower during the COVID period (P = .0286) with a negligible effect size. Violence-related injuries, injury severity, mortality, and admission characteristics including alcohol and drug testing and positivity were similar in the COVID and historic periods. DISCUSSION The SAHO resulted in a temporary decrease in trauma center admissions. Although ORV and hanging mechanisms were increased, other mechanisms such as alcohol and toxicology proportions, injury severity, length of stay, and mortality were unchanged.
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Affiliation(s)
- Gregory S Huang
- Trauma/Critical Care/General Surgery, 22987St Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | - Elisha A Chance
- Trauma/Neuroscience Research, 22987St Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | - C Michael Dunham
- Trauma/Critical Care/General Surgery, 22987St Elizabeth Youngstown Hospital, Youngstown, OH, USA
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ÇIKRIKÇI IŞIK G, ÇİNPOLAT R, KIRIŞ E, ÇEVİK Y. Evaluation of forensic medical cases during COVID-19 pandemic. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.933782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh. J Infect Public Health 2021; 15:132-137. [PMID: 34756811 PMCID: PMC8516149 DOI: 10.1016/j.jiph.2021.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients’ demographic information, acuity level, length of stay, and admission rate. Methods Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19. Results The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime. Conclusion We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.
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Kaufman EJ, Holena D, Koenig G, Martin ND, Maish GO, Moran BJ, Ratnasekera A, Stawicki SP, Timinski M, Brown J. Increase in Motor Vehicle Crash Severity: An Unforeseen Consequence of COVID-19. Am Surg 2021:31348211047466. [PMID: 34645324 PMCID: PMC8524247 DOI: 10.1177/00031348211047466] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The 2019 coronavirus (COVID-19) pandemic led to stay-at-home (SAH) orders in Pennsylvania targeted at reducing viral transmission. Limitations in population mobility under SAH have been associated with decreased motor vehicle collisions (MVC) and related injuries, but the impact of these measures on severity of injury remains unknown. The goal of this study is to measure the incidence, severity, and outcomes of MVC-related injuries associated with SAH in Pennsylvania. MATERIALS & METHODS We conducted a retrospective geospatial analysis of MVCs during the early COVID-19 pandemic using a state-wide trauma registry. We compared characteristics of patients with MVC-related injuries admitted to Pennsylvania trauma centers during SAH measures (March 21-July 31, 2020) with those from the corresponding periods in 2018 and 2019. We also compared incidence of MVCs for each zip code tabulation area (ZCTA) in Pennsylvania for the same time periods using geospatial mapping. RESULTS Of 15,550 trauma patients treated during the SAH measures, 3486 (22.4%) resulted from MVCs. Compared to preceding years, MVC incidence decreased 10% under SAH measures with no change in mortality rate. However, in ZCTA where MVC incidence decreased, there was a 16% increase in MVC injury severity. CONCLUSIONS Stay-at-home orders issued in response to the COVID-19 pandemic in Pennsylvania were associated with significant changes in MVC incidence and severity. Identifying such changes may inform resource allocation decisions during future pandemics or SAH events.
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Affiliation(s)
- Elinore J Kaufman
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Holena
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - George Koenig
- 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Niels D Martin
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - George O Maish
- Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | | | | | - Stanislaw P Stawicki
- Department of Research & Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Joshua Brown
- Division of Trauma and General Surgery, Department of Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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İlhan B, Bozdereli Berikol G, Aydın H, Arslan Erduhan M, Doğan H. COVID-19 outbreak impact on emergency trauma visits and trauma surgery in a level 3 trauma center. Ir J Med Sci 2021; 191:2319-2324. [PMID: 34618300 PMCID: PMC8496426 DOI: 10.1007/s11845-021-02793-y] [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: 09/03/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023]
Abstract
Background This study aims to compare emergency trauma visits’ severity, emergency surgical needs, and characteristics between the pandemic and pre-pandemic periods. Methods This retrospective observational study was conducted in a tertiary training and research hospital between 1 and 30 April 2020 (pandemic group) and compared with the previous year’s same dates (pre-pandemic group). Trauma patients aged 18 and over were included in the study. Emergency Severity Index (ESI) levels, trauma surgery needs, and injury characteristics were compared. Results A total of 2097 patients (592 pandemic and 1505 pre-pandemic) were included. There was an approximately 60% reduction in total and daily visits. ESI levels 1 (0.2% vs. 1.4%) and 2 (0.8% vs. 1.9%) patients increased during pandemic period. Trauma surgery needs (1.6% vs. 2.2%), intensive care unit (ICU) admission (0.4% vs. 0.2%), and ward admission (6.3% vs. 7.9%) did not change during pandemic period. Conclusion Despite the decrease in the visit frequency of adult trauma patients during the pandemic period, the needs for trauma surgery, ICU, and ward admission did not change. Trauma teams should continue their duties during the pandemic period.
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Affiliation(s)
- Buğra İlhan
- Department of Emergency, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Göksu Bozdereli Berikol
- Department of Emergency, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Aydın
- Department of Emergency, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Müge Arslan Erduhan
- Department of Emergency, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Halil Doğan
- Department of Emergency, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Impact of the COVID-19 pandemic on trauma activations at a pediatric level 1 trauma center in New York. Pediatr Surg Int 2021; 37:1409-1414. [PMID: 34264357 PMCID: PMC8280274 DOI: 10.1007/s00383-021-04962-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND The disruptive effects on society and medical systems due to the coronavirus disease 2019 (COVID-19) pandemic are substantial and far-reaching. The effect of the pandemic on the quantity and quality of pediatric traumas is unclear and has a direct bearing on how scarce hospital resources should be allocated in a pandemic situation. METHODS A retrospective review of the trauma registry was performed for trauma activations in the years 2018 through 2020 during the months of March, April, and May. Demographic and injury specific datapoints were compared across calendar years. RESULTS There were 111, 100, and 52 trauma activations during the study interval in 2018, 2019, and 2020, respectively. There were fewer highest severity level activations in 2020 compared to 2018 and 2019 (1 vs 5 and 9; p < 0.01). The median Injury Severity Score was 5 in 2020 compared to 4 in both 2018 and 2019 (p < 0.01). More patients went directly to the operating room in 2020 compared to prior years (21.2% vs 8% and 6.1%; p < 0.01). There were fewer discharges from the emergency department (ED) (12.1% vs 36.6% and 32.7%). No increase in the number of child abuse reports and investigations was noted. There was no difference in the proportion of blunt versus penetrating trauma between years (p = 0.57). No pedestrians were struck by automobiles in 2020 compared to 12 and 14 in 2018 and 2019. However, there were a greater proportion of injuries from falls during 2020 compared to prior years. CONCLUSIONS There were fewer trauma activations during the peak of the COVID pandemic compared to prior years. Due to the decrease in trauma volume during the peak of the pandemic, hospital resources could potentially be reallocated toward areas of greater need. LEVEL OF EVIDENCE IV; Retrospective cohort study using historical controls.
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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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Yu JS, Rodrigues AJ, Bovonratwet P, Shen T, Premkumar A, Sehgal R, Carr II JB, Dines JS, Ricci WM. Changes in Orthopaedic diagnoses during the COVID-19 pandemic. J Clin Orthop Trauma 2021; 22:101603. [PMID: 34580568 PMCID: PMC8458105 DOI: 10.1016/j.jcot.2021.101603] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/12/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by significant reductions in patient volumes for non-COVID-19-related conditions ranging from acute coronary syndrome to ischemic strokes to acute trauma. However, the impact of the COVID-19 pandemic on patient volumes for a broad range of orthopedic conditions remains unknown. The purpose of this study was to investigate the association of the COVID-19 pandemic with changes in patient volumes of 35 emergent (e.g. dislocations, open fractures), urgent (e.g. fractures), and nonurgent orthopedic conditions (e.g. osteoarthritis, sprains). METHODS A retrospective interrupted time-series analysis of patient volumes was conducted for 35 orthopedic conditions based on ICD-10 diagnosis codes. Patient hospitalizations and new problem visits were aggregated across two institutions in New York state, including one urban tertiary care orthopedic hospital, one urban academic medical center, and all state outpatient facilities affiliated with the orthopedic institution. Patient volumes in the COVID-19 peak period (03/2020-05/2020) and COVID-19 recovery period (06/2020-10/2020) were compared against pre-COVID-19 vol (01/2018-02/2020). RESULTS Overall, 169,047 cases were included in the analysis across 35 conditions with 3775 emergent cases, 6376 urgent cases, and 158,896 nonurgent cases. During the COVID-19 peak period, patient caseloads for 1 out of 7 emergent conditions (p = 0.02) and 26 out of 28 urgent and nonurgent conditions (p < 0.05) were significantly reduced compared to the pre-COVID-19 period. During the COVID-19 recovery period, patient volumes in 3 out of 13 emergent and urgent conditions (p < 0.03) and 11 out of 22 nonurgent conditions (p < 0.04) were decreased compared to pre-COVID-19 vol. CONCLUSIONS This study found that the pandemic was associated with considerable changes in patient patterns for non-COVID-19 orthopedic conditions. The long-term effects of patient volume reductions on both patient outcomes and orthopedic health systems remain to be seen. LEVEL OF EVIDENCE Cohort study; level of evidence IV.
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Affiliation(s)
- Jonathan S. Yu
- Weill Cornell Medicine, New York, NY, USA,Corresponding author. Cornell Medical College 420 E 70th St, Unit 13F New York, NY 10021, USA.
| | | | | | - Tony Shen
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - James B. Carr II
- Weill Cornell Medicine, New York, NY, USA,Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | - Joshua S. Dines
- Weill Cornell Medicine, New York, NY, USA,Hospital for Special Surgery, New York, NY, USA
| | - William M. Ricci
- Weill Cornell Medicine, New York, NY, USA,Hospital for Special Surgery, New York, NY, USA
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Murrett J, Fu E, Maher Z, Bae C, Satz WA, Schreyer KE. Impact of COVID-19 and Shelter in Place on Volume and Type of Traumatic Injuries. West J Emerg Med 2021; 22:1060-1066. [PMID: 34546881 PMCID: PMC8463046 DOI: 10.5811/westjem.2021.5.49968] [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: 09/21/2020] [Accepted: 05/23/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Very little is known about the effects of the novel coronavirus (COVID-19) pandemic and its associated social distancing practices on trauma presentations to the emergency department (ED). This study aims to assess the impact of a city-wide stay at home order on the volume, type, and outcomes of traumatic injuries at urban EDs. Methods The study was a retrospective chart review of all patients who presented to the ED of an urban Level I Trauma Center and its urban community affiliate in the time period during the 30 days before the institution of city-wide shelter-in-place (preSIP) order and 60 days after the shelter-in-place (SIP) order and the date-matched time periods in the preceding year. Volume and mechanism of traumatic injuries were compared using paired T-tests. Results There was a significant decrease in overall ED volume. The volume of certain blunt trauma presentations (motor vehicle collisions) during the first 60 days of SIP compared to the same period from the year prior also significantly decreased. Importantly, the volume of penetrating injuries, including gunshot wounds and stab wounds, did not differ for the preSIP and SIP periods when compared to the prior year. The mortality of traumatic injuries was also unchanged during the SIP comparison period. Conclusion While there were significant decreases in visits to the ED and overall trauma volume, penetrating trauma, including gun violence, and other severe traumatic injuries remain a public health crisis that affects urban communities despite social distancing recommendations enacted during the COVID-19 pandemic.
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Affiliation(s)
- James Murrett
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Emily Fu
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Zoe Maher
- Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Crystal Bae
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Wayne A Satz
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Kraftin E Schreyer
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
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Rudisill TM. The association between a statewide stay-at-home order and motor vehicle injury rates among population sub-groups in West Virginia. TRAFFIC INJURY PREVENTION 2021; 22:501-506. [PMID: 34410833 PMCID: PMC8489257 DOI: 10.1080/15389588.2021.1960320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). METHODS A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. RESULTS There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. CONCLUSIONS West Virginia's Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.
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Affiliation(s)
- Toni M Rudisill
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia
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Giudici R, Lancioni A, Gay H, Bassi G, Chiara O, Mare C, Latronico N, Pesenti A, Faccincani R, Cabrini L, Fumagalli R, Chieregato A, Briani L, Sammartano F, Sechi G, Zoli A, Pagliosa A, Foti G, Borotto E, Palo A, Valoti O, Botteri M, Carlucci M, Reitano E, Bini R. Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry. World J Emerg Surg 2021; 16:39. [PMID: 34281575 PMCID: PMC8287111 DOI: 10.1186/s13017-021-00383-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
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Affiliation(s)
- Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Armando Lancioni
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Hedwige Gay
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Osvaldo Chiara
- Emergency Department, General Surgery and Trauma Team, ASST Niguarda, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milano, Italy.
| | - Claudio Mare
- Regional Agency of Emergency and Urgency, Milan, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione Policlinico, University of Milan, Milan, Italy
| | | | - Luca Cabrini
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.,Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Milan, Italy
| | - Arturo Chieregato
- Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, Milan, Italy
| | - Laura Briani
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
| | - Fabrizio Sammartano
- Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, Milan, Italy
| | | | - Alberto Zoli
- Regional Agency of Emergency and Urgency, Milan, Italy
| | | | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, S.Gerardo Hospital, University Milano Bicocca, Monza, Italy
| | - Erika Borotto
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Marco Botteri
- Regional Agency of Emergency and Urgency, Brescia, Italy
| | - Michele Carlucci
- General and Emergency Surgery and Emergency Department, Ospedale San Raffaele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Roberto Bini
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
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Epidemiology of pediatric trauma during the COVID-19 pandemic shelter in place. Surg Open Sci 2021; 6:5-9. [PMID: 34308327 PMCID: PMC8275016 DOI: 10.1016/j.sopen.2021.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction The first COVID-19 cases occurred in the US in January of 2020, leading to the implementation of shelter in place. This study seeks to define the impact of shelter in place on the epidemiology of pediatric trauma. Methods We examined pediatric trauma admissions at 5 Level 1 and 1 Level 2 US pediatric trauma centers between January 1 and June 30, 2017–2020. Demographic and injury data were compared between pre– and post–shelter in place patient cohorts. Results A total of 8772 pediatric trauma activations were reviewed. There was a 13% decrease in trauma volume in 2020, with a nadir at 16 days following implementation of shelter in place. Injury severity scores were higher in the post–shelter in place cohort. The incidence of nonmotorized vehicle accidents and gunshot wounds increased in the post–shelter in place cohort. Conclusion We found an overall decrease in pediatric trauma volume following shelter in place. However, injuries tended to be more severe. Our findings help inform targeted injury prevention campaigns during future pandemics. Shelter-in-place policies led to a 13% decrease in overall pediatric trauma volume. Biggest decrease occurred in the 30 days surrounding the start of shelter in place. Nonmotorized vehicle accidents and gunshot wounds increased with shelter in place. Injury severity was higher among the shelter-in-place cohort compared to controls. The incidence of nonaccidental trauma did not change with shelter in place.
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Salomon B, Howk A, Heidel R, McKnight CL. Impact of coronavirus disease 2019 (COVID-19) on trauma surgical education at a level I trauma center. Surgery 2021; 170:1359-1363. [PMID: 34116858 PMCID: PMC8141696 DOI: 10.1016/j.surg.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 pandemic, trauma presentations to the emergency room decreased across the country. The goal of this study is to analyze the educational impact of coronavirus disease 2019 on trauma education and training at a level I trauma center. METHODS Trauma patient presentations were analyzed 6 months before a Tennessee executive stay-at-home order and 6 months after the state executive order. To control for the seasonal trauma volumes, an additional 6 months before the executive order was then analyzed comparing month to month. Total number of presentations, demographics, procedures, airway management, and coronavirus disease 2019 status of patients and residents were analyzed. RESULTS The number of trauma presentations were sustained after executive orders at our level I trauma center. There was no significant difference in intubations, central line placements, and chest tube placements before and during the pandemic. Blunt trauma decreased after stay-at-home orders. Of the 36 residents, no residents tested positive during the study period. CONCLUSION Trauma-focused surgical education was not affected at an academic level I trauma center. Understanding that it is region, city, and hospital specific, this study shows that quality trauma education can continue throughout the coronavirus disease 2019 pandemic while keeping trainees safe. Proper airway management, personal protective equipment, social distancing, and coronavirus disease 2019-preventative protocols seem to protect residents from potential harm while allowing them to participate and continue in quality trauma education and training.
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Affiliation(s)
- Brett Salomon
- Department of Surgery, University of Tennessee at Knoxville Graduate Medical Education, TN.
| | - Amy Howk
- Department of Surgery, University of Tennessee at Knoxville Graduate Medical Education, TN
| | - Robert Heidel
- Division of Biostatistics, Department of Surgery, University of Tennessee Medical Center at Knoxville, TN
| | - C Lindsay McKnight
- Division of Trauma and Critical Care Surgery, Department of Surgery, University of Tennessee Medical Center at Knoxville, TN
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Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Guzzini M, Ferretti A. The Effect of Shelter-In-Place on Orthopedic Trauma Volumes in Italy During the COVID-19 Pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021216. [PMID: 33988156 PMCID: PMC8182575 DOI: 10.23750/abm.v92i2.10827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system. Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. MATERIALS AND METHODS We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. RESULT The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). CONCLUSION Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.
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Affiliation(s)
- Valerio Andreozzi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Fabio Marzilli
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Leonardo Previ
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Romano Cantagalli
- 1Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Matteo Guzzini
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Sanford EL, Zagory J, Blackwell JM, Szmuk P, Ryan M, Ambardekar A. Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital. J Pediatr Surg 2021; 56:918-922. [PMID: 33516579 PMCID: PMC7817462 DOI: 10.1016/j.jpedsurg.2021.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our two-institution experience. METHODS Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015-2019). RESULTS There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower (p < 0.001) during COVID-19. Burn injury admissions (p < 0.001) and penetrating trauma encounters (p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased (p < 0.001). Trauma occurred among more white (p = 0.01) and privately insured (p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes (p < 0.001), pedestrians struck by automobile (p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries (p = 0.02), falls (p < 0.001), and sports related injuries (p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance (p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era (p = 0.04). For burn admissions, there was a significant increase in flame burns (p < 0.001). CONCLUSIONS Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.
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Affiliation(s)
- Ethan L Sanford
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Children's Health, Division of Pediatric Critical Care, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Jessica Zagory
- Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health Sciences Center, New Orleans LA, United States; Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States.
| | - James-Michael Blackwell
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Peter Szmuk
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Mark Ryan
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Aditee Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States
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The impact of COVID-19 quarantine efforts on emergency radiology and trauma cases. Clin Imaging 2021; 77:250-253. [PMID: 34044266 PMCID: PMC8081751 DOI: 10.1016/j.clinimag.2021.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Amidst COVID-19 pandemic, many states have issued stay at home advisories and non-essential business closures to limit public exposure. During this "quarantine" period, it is important to understand the volume and types of emergency/trauma radiology cases to better prepare for the continuing and future pandemics. This study demonstrates new trends in pathologies and an overall increase in positive exams. METHODS A retrospective review of emergency department's imaging during the initial two weeks of this state's quarantine period, 3/23/2020-4/5/2020 was compared to similar dates of the previous year ("pre-quarantine" period), 3/25/2019-4/7/2019. One thousand emergency radiology and 991 trauma cases were evaluated. Of the emergency radiology cases 500 studies from each period were assessed, and from the trauma cases, 783 cases from pre-quarantine and 315 from the quarantine period were examined. Chi-square analysis was performed to assess for statistical significance. RESULTS Overall there were 43.0% fewer emergency radiology studies performed during the quarantine period (n = 4530) compared to pre-quarantine period (n = 2585). Additionally, the number of positive cases was significantly higher (P = 0.0001) during the quarantine period (43.0%) compared to the pre-quarantine period (30.2%). Several trends in types of trauma were observed, including a significant increase in domestic violence during the quarantine period (P = 0.0081). DISCUSSION Different volumes and types of emergency/trauma imaging cases were observed during the recent quarantine period. Findings may assist emergency radiology departments to plan for future pandemics or COVID-19 resurgences by offering evidence of the types and volume of emergency radiology cases one might expect.
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Savla P, Wiginton J, Taka TM, Patchana T, Farahmandian R, Farr S, Berry JA, Krel M, Ray K, Petrova S, Duong J, Miulli DE. Using the Decrease in Trauma Admissions During the COVID-19 Pandemic to Evaluate Compliance With Stay-at-Home and Social Distancing Guidelines. Cureus 2021; 13:e14444. [PMID: 33996308 PMCID: PMC8114965 DOI: 10.7759/cureus.14444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) virus was declared a pandemic on March 10, 2020 by the World Health Organization (WHO) and has massively burdened healthcare systems with cases exponentially rising throughout the United States and the rest of the world. Since implementing precautions to reduce the spread of this disease, emergency departments have seen a decrease in the number of traumas. By evaluating the differences in the number of trauma admissions in different subgroups of patients, we can assess where to target messaging to increase compliance with these precautions. In this study, we aim to analyze the effect of the COVID-19 pandemic on trauma admissions. Methodology This was a retrospective review of the trauma database at our institution, a level 2 trauma center in Southern California, to assess the impact of COVID-19 on the number of traumas. The inclusion criteria were patients activated as traumas, regardless of age. Patients were excluded from the study if they did not have complete information in the trauma database. Data were stratified by date into two groups: (a) COVID period (January to April 2020) and (b) pre-COVID period (January to April 2019). The primary endpoint of this study was to determine whether there was a significant change in the number of patients presenting as trauma during the COVID-19 pandemic. This difference was analyzed and divided into subgroups based on age and trauma type. Results In our review, an average of 279 patients per month presented as trauma from January to April in 2019, and an average of 222 patients per month presented as trauma from January to April 2020 (p = 0.049). We found a significant decrease in the number of patients presenting with the chief complaint of fall and vehicular accident, but a nonsignificant difference in patients presenting as assaults or pedestrian accidents. There was also a significant decrease in the number of traumas in the 18-39 and 65+ age groups and a nonsignificant decrease in the 40-64 age group. It was also noted that the number of trauma admissions in May 2020 increased to 253 compared to 269 in 2019. This increase was most notable in the 18-39 and 40-64 age groups. Discussion As seen in the data, the most notable year-over-year difference was seen in March and April. In California specifically, a stay-at-home order was set in place in March, which was in conjunction with the WHO’s declaration of a pandemic. An interesting finding was the significant decrease in patients with traumas in the age groups of 18-39 and 65+ from 2019 to 2020. There was a smaller, nonsignificant decrease in patients aged 40-64. This would be a good group to target with future messaging to increase compliance with health advisories. There was also a notable increase in the number of traumas in May 2020, signaling an end to the cooperation of the majority of people, also indicating that further measures needed to be enacted in all groups. Conclusions COVID-19 has disrupted social structures worldwide. As the pandemic continued, even the observers of stay-at-home and social distancing measures, the 18-39 age group, became fatigued with the guidelines and ventured out into the warming weather and summer activities. This difference in trauma admission due to COVID-19 between subsequent years can highlight the behavioral changes in our patient population and can be further extrapolated to target additional messaging to help reduce the spread of COVID-19.
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Affiliation(s)
- Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Taha M Taka
- Neurosurgery, University of California Riverside, Riverside, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ronit Farahmandian
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Saman Farr
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James A Berry
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Mark Krel
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Kevin Ray
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Sarah Petrova
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Jason Duong
- Neurological Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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50
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Quraishi AHM, Sahu S, Tongse P, Agrawal A. Impact of COVID-19 lockdown on the spectrum of trauma patients at a major trauma center in central India: A retrospective observational study. Int J Crit Illn Inj Sci 2021; 11:25-28. [PMID: 34159133 PMCID: PMC8183369 DOI: 10.4103/ijciis.ijciis_141_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
Context: A total lockdown was announced in India from March 25 to May 31 in four phases in response to the COVID-19 pandemic. This study aimed to study the impact of this national lockdown on the volume and the nature of injuries in patients admitted during this period at a major trauma center in central India. Methods: This is a retrospective descriptive study of prospectively collected data which were collected from the hospital records. Patients admitted to the trauma center during lockdown were compared to patients admitted in the prelockdown period for the change in volume and spectrum and severity of injuries across all age groups and both genders. Results: There was a significant fall in the overall number of trauma patients across all age groups and both genders during the lockdown period (66.8%). There was a significant decrease in numbers among males (68.1%). Road traffic accidents decreased by 75.2%. There was a relative increase in trauma due to falls and assault during the lockdown period. The mortality due to trauma decreased significantly by 79.8%. Conclusions: There has been an overall decrease in the number of patients admitted to the trauma center during the lockdown period. However, there is a relative increase in preventable injuries such as falls, assault, and animal-related injuries. Focused strategies to decrease preventable injuries need to be devised to reduce the load on overburdened resources during the COVID-19 crisis.
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Affiliation(s)
| | - Shiv Sahu
- Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
| | - Pankaj Tongse
- Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
| | - Ankit Agrawal
- Department of Surgery, Government Medical College, Nagpur, Maharashtra, India
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