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Social restrictions during COVID‐19 and major trauma volume at a level 1 trauma centre

Teagan L Way, Seth M Tarrant and Zsolt J Balogh
Med J Aust 2021; 214 (1): 38-39. || doi: 10.5694/mja2.50843
Published online: 18 January 2021

The coronavirus disease 2019 (COVID‐19) pandemic has posed a variety of significant challenges. Since March 2020, the Australian government has introduced a series of social mobility restrictions, including supervised quarantine for returning overseas travellers. In health care, resources have been re‐allocated, intensive care capacity increased, staff re‐trained, and elective surgery postponed. It was suggested that major trauma volume would decline markedly during the pandemic, so that specialist trauma staff could be deployed elsewhere.1 The frequency of self‐harm and domestic violence, however, was expected to increase.2

The purpose of our observational study was to compare major trauma volumes at the John Hunter Hospital, Newcastle, during the period 1 March – 31 May before (2011–2019; to provide a large control group) and during the COVID‐19 pandemic (2020). As the only level 1 trauma centre in the Hunter region, our hospital receives most patients from this area requiring trauma care. We analysed data routinely collected for the New South Wales trauma registry; our statistical analysis is described in the online Supporting Information. The study was granted formal ethics approval waiver by the Hunter New England Human Research Ethics Committee (reference, AU202004‐17).

Our analysis included 3315 patients from the control period and 259 from the COVID‐19 period. The age, sex, and injury severity score distributions were similar in the two groups (Box 1), as were those of mechanism of injury by month (Box 2). During the COVID‐19 period, the number of admissions (259) was lower than the control mean (368; [standard deviation (SD), 73]; P < 0.002), as were the numbers of severely injured patients (96 v 124 [SD, 16]; P < 0.001), intensive care admissions (35 v 56 [SD, 10]; P < 0.001), patients requiring ventilation (23 v 35 [SD, 9]; P = 0.006), patients requiring surgery (106 v 142 [SD, 30]; P < 0.001), and deaths (4 v 11 [SD, 3]; P = 0.004). COVID‐19 restrictions were strictest during April; the numbers of severely injured patients, patients requiring ventilation, and deaths were similar during April in the control and COVID‐19 periods (Supporting Information, table).

Fear of contracting COVID‐19 may have dissuaded people from presenting themselves to hospital, but the number of COVID‐19 cases in the catchment area for our trauma centre was relatively low (279 cases over three months, including six intensive care admissions and four deaths, from a population of one million people). Lower admission numbers were therefore probably linked to social mobility restrictions.

We found no significant changes in mechanism of injury, in contrast to two reports of significant declines in traffic, industrial, sports, and fall‐related trauma cases during periods of social restrictions.3,4

Our study was limited by its being a single‐centre study, and it was restricted to a single COVID‐19 wave in Newcastle. It included periods of no restrictions in early March, restrictions for the full month of April, and the easing of restrictions in May, a period not covered in previous studies.

Despite a lower than usual number of admissions, the demand for trauma care still required a fully functioning trauma service, and this should be taken into account by clinicians and hospital administrators when allocating resources.5 Severely injured patients require comprehensive early management, and the availability of experienced senior trauma clinicians is essential.6,7 On the basis of our experience of the first COVID‐19 wave, switching staff from trauma specialist services to pandemic management would be unwarranted.1

Box 1 – Demographic and clinical characteristics of patients admitted to the John Hunter Hospital with trauma‐related injuries, March–May, 2011–2020

Control
(Mar–May, 2011–2019)

COVID‐19 period
(Mar–May 2020)

P


Number of patients

3315

259

Age (years), mean (SD)

38 (21)

40 (23)

0.13

Sex (men)

2432 (73%)

183 (71%)

0.34

Blunt injuries

3041 (94%)

238 (94%)

0.76

Injury severity score, median (IQR)

9 (4–16)

8 (4–16)

0.21

 Severely injured patients (scores > 12), annual mean (SD)*

124 (16)

96

< 0.001

Admissions, annual mean (SD)*

368 (73)

259

0.002

 Length of stay (days), median (IQR)

3 (1–6)

3 (1–7)

0.44

Patients requiring surgery, annual mean (SD)*

142 (30)

106

< 0.001

Intensive care admissions, annual mean (SD)*

56 (10)

35

< 0.001

 Length of stay (days), median (IQR)

3 (2–5)

3 (2–8)

0.97

Ventilation required, annual mean (SD)*

35 (9)

23

0.006

 Ventilator use (days), median (IQR)

3 (2–5)

3 (2–6)

0.93

Deaths, annual mean (SD)*

11 (3)

4

0.004


IQR = interquartile range; SD = standard deviation.  * For COVID‐19 period: number.  † Ventilated patients only.

Box 2 – Mechanism of injury, by month

Mechanism of injury*

Control
(Mar–May, 2011–2019)

COVID‐19 period
(Mar–May 2020)


March

1172

80

 Traffic

411 (35%)

34 (43%)

 Recreational

383 (33%)

26 (33%)

 Fall

212 (18%)

10 (13%)

 Self‐harm and assault

118 (10%)

7 (9%)

 Other

48 (4%)

3 (4%)

April

1023

92

 Traffic

323 (32%)

32 (35%)

 Recreational

343 (33%)

32 (35%)

 Fall

179 (17%)

16 (17%)

 Self‐harm and assault

116 (11%)

8 (9%)

 Other

62 (6%)

4 (4%)

May

1120

87

 Traffic

432 (39%)

28 (32%)

 Recreational

366 (33%)

35 (40%)

 Fall

187 (17%)

13 (15%)

 Self‐harm and assault

82 (7%)

8 (9%)

 Other

53 (5%)

3 (4%)


 * Traffic: all traffic accidents on public roads; recreational: leisure activities, non‐traffic related car‐, motorcycle‐, bicycle‐ and animal‐related trauma; other: burns and unspecified mechanisms.

Received 26 June 2020, accepted 13 October 2020

  • Teagan L Way
  • Seth M Tarrant
  • Zsolt J Balogh

  • John Hunter Hospital, Newcastle, NSW


Competing interests:

No relevant disclosures.

  • 1. American College of Surgeons. Maintaining trauma center access and care during the COVID‐19 pandemic: guidance document for trauma medical directors. 2020. https://www.facs.org/quality-programs/trauma/maintaining-access (viewed July 2020).
  • 2. Balogh ZJ, Way T, Hoswell R. The epidemiology of trauma during a pandemic. Injury 2020; 51: 1243–1244.
  • 3. Wong JSH, Cheung KMC. Impact of COVID‐19 on orthopaedic and trauma service: an epidemiological study. J Bone Joint Surg Am 2020; 102: e80.
  • 4. 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: 81–86.
  • 5. Aljuboori Z, Sieg E. The early effects of social distancing resultant from COVID‐19 on admissions to a level 1 trauma center. Injury 2020; 51: 2332.
  • 6. McCullough A, Haycock J, Forward D, Moran C. Early management of the severely injured major trauma patient. Br J Anaesth 2014; 113: 234–241.
  • 7. Burrell AJC, Pellegrini B, Salimi F, et al. Outcomes of COVID‐19 patients admitted to Australian intensive care units during the early phase of the pandemic [pre‐print]; 16 Sept 2020. Med J Aust 2020; https://www.mja.com.au/journal/2020/outcomes-covid-19-patients-admitted-australian-intensive-care-units-during-early-phase

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