The impact of COVID-19 on major trauma (ISS>15) in London, across its four Level 1 centres
Publication: The Annals of The Royal College of Surgeons of England
Volume 104, Number 6
Abstract
Introduction
The COVID-19 pandemic has led to reconfiguration of healthcare resources to manage increased demand for acute hospital beds and intensive care places. Concerns were raised regarding continuing provision of critical care for non-COVID patients during the pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on patients admitted with major trauma (Injury Severity Score >15) across the four Level 1 trauma centres in London.
Methods
Data were collected from all four major trauma centres (MTCs) in London using the Trauma Audit and Research Network database and from local databases at each centre. A 2-month period from 5 March to 5 May 2020 was selected and the same period during 2019 was used to compare changes due to the pandemic.
Results
There was a 31% decrease in overall number of patients presenting to the four MTCs during the COVID-19 period compared with 2019. There was no difference in patient demographics or mechanism of injury between the two periods. Sports-related injuries and proportion of self-presentation to hospital were reduced slightly during the pandemic, although the differences were not statistically significant. The mortality rate and association between mortality and injury severity were similar. Proportion of patients requiring intensive care unit facilities also did not change.
Conclusion
Despite diversion of critical care resources to deal with COVID-related admissions, we did not observe a change in mortality rate or proportion of severely injured patients requiring critical care. Our results suggest London MTCs were able to provide their usual standard of care for critically injured major trauma (Injury Severity Score >15) patients during the pandemic.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Wu F, Zhao S, Yu B et al. A new coronavirus associated with human respiratory disease in China. Nature 2020; 579: 265–269.
2.
Islam F. Coronavirus: UK hardest hit by virus among leading G7 nations. BBC News 2020. https://www.bbc.co.uk/news/business-53222182 (cited June 2021).
3.
UK Government. Guidance: Oral statement to and away from others (social distancing). https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others (cited June 2021).
4.
Rhodes A, Ferdinande P, Flaatten H et al. The variability of critical care bed numbers in Europe. Intensive Care Med 2012; 38: 1647–1653.
5.
NHS England. Critical care bed capacity and urgent operations cancelled 2019-20 data. https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/critical-care-bed-capacity-and-urgent-operations-cancelled-2019-20-data/ (cited June 2021).
6.
NHSE & NHSI. Publications approval reference: 001559. Specialty guides for patient management during the coronavirus pandemic Clinical guide for the management of major trauma patients during the coronavirus pandemic 26 March 2020 Version 1 National major trauma system. https://madeinheene.hee.nhs.uk/Portals/0/Major%20Trauma%20Clinical%20Guide%2027%20March.pdf (cited June 2021).
7.
Illman J. Coronavirus response could create ‘very serious unintended consequences’. HSJ, https://www.hsj.co.uk/policy-and-regulation/coronavirus-response-could-create-very-serious-unintended-consequences/7027321.article (cited June 2021).
8.
TARN Database. The Trauma Audit and Research Network. https://www.tarn.ac.uk/ (cited June 2021).
9.
Elm EV, Altman DG, Egger M et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12: 1495–1499.
10.
Health Research Assessment Tool. UKRI Medical Research Council. http://www.hra-decisiontools.org.uk/research/ (cited June 2021).
11.
Fojut R. How coronavirus is affecting trauma systems in Italy. Trauma System News March 21, 2020. https://www.trauma-news.com/2020/03/how-coronavirus-is-affecting-trauma-systems-in-italy/ (cited June 2021).
12.
Park C, Sugand K, Nathwani D et al. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the ‘golden month’. Acta Orthop 2020; 91: 556–561.
13.
Scott CEH, Holland G, Powell-Bowns MFR et al. Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority. Bone & Joint Open 2020; 1.
14.
Tahmassebi R, Bates P, Trompeter A et al. Reflections from London’s level-1 major trauma centres during the COVID crisis. Eur J Orthop Surg Traumatol 2020; 30: 951–954.
15.
Christey G, Amey J, Campbell A, Smith A. Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. N Z Med J 2020; 133: 81–88.
16.
Way TL, Tarrant SM, Balogh ZL. The effect of COVID-19 social restrictions on major trauma volumes and resource utilisation at a level 1 trauma centre. Med J Aust 2020. https://www.mja.com.au/journal/2020/effect-covid-19-social-restrictions-major-trauma-volumes-and-resource-utilisation (cited June 2021).
17.
Rajput K, Sud A, Rees M, Rutka O. Epidemiology of trauma presentations to a major trauma centre in the north west of england during the COVID-19 level 4 lockdown. Eur J Trauma Emerg Surg 2021; 47: 631–636.
18.
Adiamah A, Moody N, Blackburn L et al. ICON trauma (impact of COVID-19 on major trauma workload). Br J Surg 2020. doi:10.1002/bjs.11855
Information & Authors
Information
Published In
The Annals of The Royal College of Surgeons of England
Volume 104 • Number 6 • June 2022
Pages: 437 - 442
PubMed: 34845936
Copyright
Copyright © 2021, All rights reserved by the Royal College of Surgeons of England.
History
Accepted: 4 June 2021
Published online: 30 November 2021
Published in print: June 2022
Keywords
Authors
Metrics & Citations
Metrics
Article Metrics
Views
33
Citations
Export citation
Select the format you want to export the citation of this publication.
View Options
Get Access
Login Options
Check if you have access through your login credentials or your institution to get full access on this article.
Purchase Options
Save for laterSubscribe and get full access to this article.