Reallocation of Hospital Resources During COVID-19 Pandemic and Effect on Trauma Outcomes in a Resource-Limited Setting

Abstract

INTRODUCTION: The COVID-19 pandemic has caused unprecedented disruption to surgical care worldwide, particularly in low-resource countries. We sought to characterize the association between pre- and intrapandemic trauma clinical outcomes at a busy tertiary hospital in Malawi. METHODS: We analyzed trauma patients who presented to Kamuzu Central Hospital in Lilongwe, Malawi, from 2011 through July 2021. Burn patients were excluded. We compared patients based on whether they presented before or during the pandemic, defined as March 11, 2020, the date of the official WHO designation. We used modified Poisson modeling to estimate the adjusted risk of death based on presentation. RESULTS: A total of 138,750 patients presented during the study period, with 13,901 patients during the pandemic. During the pandemic, patients were more likely to be older (mean 28 vs 25 years, p < 0.001), men (79 vs 74%, p < 0.001), and experience a traumatic brain injury (TBI) as their primary injury (9.7 vs 5.0%, p < 0.001). Crude trauma-associated mortality was higher during the pandemic at 3.7% vs 2.1% (p < 0.001). The risk ratio of mortality during the pandemic compared with prepandemic presentation was 1.17 (95% CI 1.09, 1.26) adjusted for age, sex, initial Alert, Voice, Pain, Unresponsive (AVPU) score, and injury type. Difference in the adjusted risk increased as age increased. (Figure).FigureCONCLUSION: During the pandemic, adjusted trauma-associated mortality significantly increased at a tertiary trauma center in a low-resource setting. Potential targets for improvement are addressing nursing shortage and reassignment along with shifts in intensive care use needed for COVID-19 patients. Further research is urgently needed to prepare for future pandemics.