The Detrimental Impact of the COVID‐19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study

Abstract

Background: The COVID-19 pandemic had a profound impact on healthcare in general and on the availability of emergency services. Immediate access to specialised services, including intensive care unit (ICUs), is potentially endangered during a pandemic. Severely injured patients highly rely on these resources, shortage may influence their outcome. We therefore evaluated the impact of the COVID-19 pandemic on the outcome of major trauma patients.Methods: A nationwide comprehensive multi-centre prospective observational cohort study, based on the Dutch National Trauma Registry was performed to compare the patient characteristics, resource usage, and outcome of major trauma patients treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23rd through May 10th) in 2020 versus pre–COVID-19 reference periods in 2018 and 2019.Findings: During the COVID-19 peak period, 502 major trauma patients were admitted, versus 566 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (46·1% versus 53·3%; p=0·008). The subgroup of 155 major trauma patients with less severe brain injuries (abbreviated injury score ≤3) were in particular less often admitted to the ICU during the peak (36·1% vs 52 ·1%; p=0·001). Moreover, this subgroup showed increased mortality compared to the reference group (14·2% vs 7·7%; p=0·023). In addition, a significant increase in observed versus predicted mortality was also recorded for patients who had a priori predicted mortality of 50% to 75% (p=0·012).Interpretation: We speculate that the restricted availability of ICU beds negatively influenced the outcome of major trauma patients during the COVID-19 peak in 2020. In particular for patients with less severe traumatic brain injuries or with a high mortality probability.Funding: None to declare. Declaration of Interest: All authors declare no conflict of interest, including financial, consultant, institutional, and other relationships that might lead to bias or conflict of interestEthical Approval: This study was approved by the Scientific Advisory Board, as well as the Board of the Dutch Emergency Care Network.