Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry.
Adult
COVID-19
/ epidemiology
Comorbidity
Delivery of Health Care
/ trends
Female
Hospital Mortality
/ trends
Hospitalization
/ trends
Humans
Injury Severity Score
Intensive Care Units
/ statistics & numerical data
Italy
Male
Middle Aged
Pandemics
Registries
Retrospective Studies
Trauma Centers
/ statistics & numerical data
Wounds and Injuries
/ diagnosis
COVID-19
Emergency
Trauma
Trauma care
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
19 07 2021
19 07 2021
Historique:
received:
22
05
2021
accepted:
07
07
2021
entrez:
20
7
2021
pubmed:
21
7
2021
medline:
6
8
2021
Statut:
epublish
Résumé
The 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. A 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. During 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). The 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.
Sections du résumé
BACKGROUNDS
The 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.
METHODS
A 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.
RESULTS
During 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).
CONCLUSIONS
The 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.
Identifiants
pubmed: 34281575
doi: 10.1186/s13017-021-00383-y
pii: 10.1186/s13017-021-00383-y
pmc: PMC8287111
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
39Informations de copyright
© 2021. The Author(s).
Références
Lancet Psychiatry. 2020 Apr;7(4):e21
pubmed: 32199510
Crit Care Med. 2005 Jun;33(6):1239-42
pubmed: 15942337
Disaster Med Public Health Prep. 2009 Mar;3(1):18-26
pubmed: 19293740
Scand J Trauma Resusc Emerg Med. 2008 Aug 28;16:7
pubmed: 18957069
Updates Surg. 2020 Jun;72(2):297-304
pubmed: 32583216
J Clin Med. 2020 Sep 30;9(10):
pubmed: 33007955
Asian J Psychiatr. 2020 Aug;52:102066
pubmed: 32302935
World J Emerg Surg. 2013 Aug 12;8:32
pubmed: 23937969
Int Orthop. 2020 Aug;44(8):1473-1480
pubmed: 32451655
Int Orthop. 2020 Oct;44(10):1921-1925
pubmed: 32676778
Scand J Trauma Resusc Emerg Med. 2020 Jun 23;28(1):57
pubmed: 32576208
J Trauma Acute Care Surg. 2020 Oct;89(4):821-828
pubmed: 32618967
Am J Disaster Med. 2008 Jan-Feb;3(1):52-6
pubmed: 18450280
Crit Care. 2015 Mar 18;19:111
pubmed: 25887150
Encephale. 2020 Jun;46(3):193-201
pubmed: 32370982
JAMA. 2020 Apr 28;323(16):1545-1546
pubmed: 32167538
West J Emerg Med. 2020 May 22;21(4):819-822
pubmed: 32726250
Ann Surg. 2020 Sep 1;272(3):e204-e207
pubmed: 32452950