Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls

OBJECTIVE

to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic.

METHOD

a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018.

RESULTS

a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period.

CONCLUSIONS

there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.

Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study

OBJECTIVE

to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (flags), as well as compare the results with the pre-pandemic period.

METHODS

a cross-sectional study was performed, with probability sampling, in a trauma center in Brazil. Medical records of patients involved in traffic accidents from June 2020 to May 2021 were evaluated. Aside from epidemiological characteristics, variables such as the current flag, the trauma mechanism, the resulting injuries, and the Revised Trauma Score (RTS) were also considered. Data were compared between three different flag periods and the proportion of consultations during the pandemic was compared with that from pre-pandemic time (December 2016 to February 2018).

RESULTS

it was observed that 62.2% of the patients were victims of motorcycle accidents, 77.5% were male, and the mean age was 33 ± 12.4 years. The mean and median RTS were 7.5 and 7.8, respectively. Statistical difference was stated when comparing the number of visits per day between the yellow and red flags (p=0.001) and orange and red flags (p=0.016). A significantly lower number of consultations for traffic accidents was observed in the pandemic when compared to the pre-pandemic period.

CONCLUSIONS

the epidemiological profile of the study consisted mostly of young men who were victims of motorcycle accidents. There was a lower incidence of admissions during red flag periods and a lower proportion of consultations throughout the survey when compared to the pre-pandemic period.

Elective surgeries in the "new normal" post-COVID-19 pandemic: to test or do not test?

The new coronavirus (SARS-CoV-2) pandemic has been wreaking havoc all over the planet. In a precautionary measure, populations have been forced and kept under quarantine to contain the outbreak of the COVID-19 disease. The quarantine primary goal is to avoid the overload to the hospitals, which should be available for the care of COVID-19 patients. However, the virus does not have a uniform spread throughout the planet, and Brazil is no different. Although all the world's attention is now on the COVID-19 pandemic, there is no similar pattern of spread, and other diseases are still a real problem. Given the risks of transmission between patients and healthcare providers, there is a great challenge for healthcare institutions who must balance resources to assure safe care to patients and professionals while they take care of other disease patients, and perform surgical procedures that need to be carried out. Under such circumstances, as COVID-19 can also present pre- or asymptomatic transmission, it can be challenging to identify patients who are carrying and spreading the virus. Studies and information on mandatory testing for who are candidates to undergo elective surgery are scarce. Thus, the authors have reviewed the literature, and discuss the need to test these patients under the current context.

The recommendations of the Brazilian College of Surgeons and the Brazilian Bariatric and Metabolic Surgery Societies on the return of bariatric and metabolic operations in geographic regions of the country where the procedures have been allowed by local policies, in the period of COVID-19 pandemic

Prioritizing surgical procedures aims at facilitating patient's access according to the clinical needs, maximizing access equity, and minimizing the damage from delayed access. Previous categorization of elective bariatric surgery have been adapted to define an objective prioritizing system that reflects those principles for bariatric and metabolic operations. Given the factors that contribute to the morbidity and mortality of obese and type 2 diabetes patients, surgical prioritization should be based on clinical risk stratification. For patients with type 2 diabetes, we suggest that the operation may be prioritized for those with a higher risk of morbidity and mortality in a relatively short term. Likewise, it is necessary to guide the surgical team regarding the necessary care both in the pre, per and postoperative periods of bariatric and metabolic surgery. These recommendations aim to reduce the risk of in-hospital contamination of the surgical team among health professionals and between health professionals and patients. In summary, these recommendations have been shaped after a thorough analysis of the available literature and are extremely important to mitigate the harm related to the clinical complications of obesity and its comorbidities while keeping healthcare providers' and patients' safety.

Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms

Objective:

to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital.

Methods:

we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality.

Results:

we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p <0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups.

Conclusion:

the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma.

Objetivo:

analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário.

Métodos:

estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencefálico. As variáveis analisadas foram: sexo, idade, dia da semana, mecanismo de trauma, tipo de transporte, RTS, tempo de internamento e mortalidade.

Resultados:

analisou-se 200 pacientes, com média de idade de 36,42 ± 17,63 anos, sendo 73,5% do sexo masculino. A média de idade no G1 foi significativamente menor do que nos demais grupos (p <0,001). A maioria (40%) dos atendimentos ocorreu nos finais de semana e o serviço de transporte pré-hospitalar mais frequente (58%) foi o SIATE (Serviço Integrado de Atendimento ao Trauma em Emergência). O tempo de internamento foi significativamente maior no G1, em comparação aos demais grupos (p <0,01). Quanto à mortalidade, houve 12%, 1,35% e 3,95% de óbitos nos grupos G1, G2 e G3, respectivamente. A mediana do RTS entre os óbitos foi 5,49, 7,84 e 1,16, respectivamente, para os três grupos.

Conclusão:

a maioria dos pacientes eram homens jovens. O RTS mostrou-se efetivo na predição de mortalidade no trauma cranioencefálico, entretanto falhou ao analisar pacientes vítimas de trauma contuso e penetrante.