Pre-hospital and Hospital Trauma Care during the Covid-19 Lockdown - Experience in a Metropolitan European Level 1 Trauma Centre.

Abstract

Trauma case load is said to have declined during the Covid-19 pandemic, especially during the national lockdowns. Due to the altered frequency and changes in daily life, pre-hospital care (altered personal protective measurements) as well as mechanisms of trauma and initial trauma treatment may have changed. The purpose of this study was to assess differences in pre-hospital as well as initial treatment of trauma victims and trauma mechanisms during a national lockdown compared to the year before. Pre-hospital as well as clinical data from all trauma patients admitted to our metropolitan level 1 trauma center resuscitation room during the hard lockdown in Switzerland (March 17 to April 26, 2020) and the same time period in 2019 were analyzed retrospectively. In total, we assessed 91 patients (51 lockdown cohort, 40 control cohort) with a mean age of 50.7 years. Significantly more trauma was sustained in the household environment during the lockdown (p=0.015). Pre-hospital treatment remained similar between the two assessed groups. No difference was found in length of stay or mortality. In severely injured patients (ISS >15), we found significantly fewer motor vehicle accidents (p=0.018) and fewer horizontal decelerations (p=0.006), but insignificantly more falls (p=0.092) in the lockdown cohort. None of the patients in the lockdown cohort had a positive PCR test for Covid-19 on admission. Trauma systems seem not to have changed during hard lockdowns in terms of pre-hospital treatment. Fewer severely injured patients due to motor vehicle accidents and horizontal decelerations, but more household-related injuries were seen in the lockdown cohort than in the control cohort. A qualitative analysis of treatment during the hard lockdown is needed to gain further insights into the effect of the pandemic on trauma care.