Abstract
BackgroundsThe 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.MethodsA 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.ResultsDuring 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).ConclusionsThe 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.
Highlights
The COVID-19 epidemic started in Italy on February 21, 2020, with the first Italian case diagnosed in Codogno, a little town in Lombardia, a region of the Northern Italy
The COVID-19 outbreak affected the epidemiology of severe trauma patients
Though the absolute number of trauma patients transported by Emergency Medical System (EMS) was reduced by 35% during the COVID19 outbreak, the percent of trauma patients admitted to the three hubs was significantly increased (Table 1)
Summary
The COVID-19 epidemic started in Italy on February 21, 2020, with the first Italian case diagnosed in Codogno, a little town in Lombardia, a region of the Northern Italy. As the spread of COVID-19 was rapid and devastating in this highly populated area, all emergency departments (ED) were suddenly put under pressure by an overwhelming number of patients with acute respiratory distress requiring intensive care unit (ICU) support. A Regional Emergency Committee (REC) was established and the regional health system reorganized. This reorganization included the interruption of elective surgical activities in order to increase the number of available ward beds and redirect the time of the anesthesiology staff, who began converting operating and recovery rooms into additional intensive care unit beds [1]. Due to the epidemic outbreak, the REC established a lockdown policy starting on March 8, and a decrease of road-related trauma patients was anticipated. The American College of Surgeons Committee on Trauma (ACS-COT) [3] guidelines for COVID response provided a general framework for the pandemic response, stating to preserve the hospital capacity for severe trauma patients through a reorganization of the regional systems
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