Abstract
BackgroundThe global pandemic caused by SARS-CoV-2 has impacted population health and care delivery worldwide. As information emerges regarding the impact of “lockdown measures” and changes to clinical practice worldwide; there is no comparative information emerging from the United Kingdom with regard to major trauma.MethodsThis observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020–18/05/2020) to a historical cohort of patients admitted during a similar time period in 2019 (11/03/2019–20/05/2019). Differences in demographics, Clinical Frailty Scale, SARS-CoV-2 status, mechanism of injury and injury severity were compared using Fisher’s exact and Chi-squared tests. Univariable and multivariable logistic regression analyses examined the associated factors that predicted 30-days mortality.ResultsA total of 642 patients were included, with 405 in the 2019 and 237 in the 2020 cohorts, respectively. 4/237(1.69%) of patients in the 2020 cohort tested positive for SARS-CoV-2. There was a 41.5% decrease in the number of trauma admissions in 2020. This cohort was older (median 46 vs 40 years), had more comorbidities and were frail (p < 0.0015). There was a significant difference in mechanism of injury with a decrease in vehicle related trauma, but an increase in falls. There was a twofold increased risk of mortality in the 2020 cohort which in adjusted multivariable models, was explained by injury severity and frailty. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables.ConclusionPatients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality.
Highlights
In response to the global pandemic caused by SARS-CoV-2, the government of the United Kingdom (UK), in line with World Health Organisation advice [1], implemented a period of lockdown in an attempt to reduce the rate of transmission
This study demonstrated that behavioural change as a result of the legislation enforcing a lockdown in the UK had a marked effect on the volume and demographic of major trauma presentations
Major Trauma was associated with young, healthy males with little co-morbidity [24], this study demonstrates that the SARS-CoV-2 pandemic and associated lockdown measures, have accelerated the ‘changing face of trauma’ described by Kehoe et al [21]
Summary
In response to the global pandemic caused by SARS-CoV-2, the government of the United Kingdom (UK), in line with World Health Organisation advice [1], implemented a period of lockdown in an attempt to reduce the rate of transmissionThe members of the ICON Trauma Study Group was processed under acknowledgements section.of the virus. The seasonal variability in trauma admissions is well documented [5,6,7] This has been attributed to decreased trauma incidents during the Easter and Christmas holidays and an increased pattern during Summer, school holidays and national bank holidays [5,6,7]. Whether this pattern will be replicated during a UK national lockdown; and the effect on the rate, type and severity of trauma presentations, is unclear. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables. Conclusion Patients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality
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