Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
EDITORIAL  
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 73-74
What's new in emergencies, trauma, and shock: Trauma admissions during Covid-19 lockdown


1 Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
2 Rutgers New Jersey Medical School, Newark, NJ, USA
3 Department of Surgery, Morristown Medical Center, Morristown, NJ; Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA

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Date of Submission07-Feb-2021
Date of Acceptance07-Feb-2021
Date of Web Publication25-Jun-2021
 

How to cite this article:
Soliman SS, DiFazio LT, Hakakian D, Buchsbaum J, Pourghaderi P, Nemeth ZH. What's new in emergencies, trauma, and shock: Trauma admissions during Covid-19 lockdown. J Emerg Trauma Shock 2021;14:73-4

How to cite this URL:
Soliman SS, DiFazio LT, Hakakian D, Buchsbaum J, Pourghaderi P, Nemeth ZH. What's new in emergencies, trauma, and shock: Trauma admissions during Covid-19 lockdown. J Emerg Trauma Shock [serial online] 2021 [cited 2021 Nov 30];14:73-4. Available from: https://www.onlinejets.org/text.asp?2021/14/2/73/319405




On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a global pandemic.[1] With its vast emergence and virulence, the British Orthopedic Association and the Royal Colleges of Surgeons created guidelines for the management of orthopedic trauma admissions.[2] These recommendations were established to reduce the spread of the virus and to better reallocate hospital resources.[2] Therefore, the authors of a study being published in this issue[3] sought to elucidate changes in orthopedic trauma admissions, as well as surgical case volume in the 5-week period of lockdown from March 23, 2020, to April 26, 2020, during which new guidelines were implemented. Their hospital was reconstructed to solely accept urgent orthopedic trauma cases and patient transfers while canceling all elective surgeries. All trauma admissions were retrospectively compared in the “control” period (March 23–April 26, 2019) to the 5-week “lockdown” in 2020.

The scope of this study is novel to the United Kingdom (UK) as it attempts to delineate the effect of COVID-19 on orthopedic trauma admissions specific to the region. This adds value to orthopedic trauma literature as it solely utilizes homogeneous populations and is more likely to be generalizable to this specific service. A similar study was conducted at the Morristown Medical Center in the United States; however, the authors investigated the rates of all trauma admissions before and during the COVID-19 era.[3]

This study in the UK demonstrates that rates of trauma admissions and surgeries decreased during the COVID-19 era. Similar findings were documented in other continents of the globe.[4],[5],[6] These reductions increased resource reserves that can be readily reallocated to other health-care facilities and departments dealing directly with the COVID-19 crisis. Moreover, this can reduce patient and hospital staff risk of COVID-19 acquisition and further transmission of the virus. Studies like this one are vital as they deduce the efficiency of emergency surgery guidelines and provide clinical insight for hospital administrators and leadership when encountering similar challenges in the future. Furthermore, this study also suggests that resource reallocation may need to be specific to various injury types and demographics. Specifically, while there was a clear decrease in high-energy injuries, there was an increase in low-energy injuries during the COVID-19 era. Of the low-energy injuries, hip fractures were the most common type, accounting for half of all injuries. The rates of sustaining a hip fracture between the COVID-19 era and before COVID-19 were unabated, signifying that resources may still need to remain in place for populations, such as the elderly, and for certain types of trauma. Additionally, it is also important to highlight that the increase in low-energy traumas was likely a result of an increase in at-home activities due to pandemic-related work-from-home arrangements and job site closures.

As previously noted, the study suggests that high-energy mechanisms of trauma and resulting injuries have decreased. However, a comparison of injury severity score could be advantageous for validating this argument. This parameter was analyzed in a study from Morristown Medical Center in the United States, which demonstrated decreased rates of trauma admissions, and significantly lower ISS values for the COVID-19 era cohort.[4] Although the study from the UK noted an increase in the proportion of hip fractures relative to other trauma admissions, the total number of hip fractures in the COVID-19 era was lower than that of the pre-COVID-19 era (66 in the COVID-19 era cohort versus 106 in the pre-COVID-19 era). The authors state that it was unexpected to see an overall reduction in hip fracture numbers, however, the difference in number is comprehensible as the overall volume of trauma patients during the COVID-19 era was significantly lower.

This study has limitations, which were disclosed by the authors. The lockdown reportedly lasted for 7 weeks; however, this study solely analyzed the first 5 weeks of that period. The rationale for this was that the 5 weeks' worth of data would be ample and representative of the entire duration of the lockdown. However, with the lockdown only being 2 more weeks than what the study accounted for, it would be more representative to include all 7 weeks' worth of data. Furthermore, while the trends demonstrated in the study were expected, the rates may not be generalizable to the entire UK. This study solely used regional data centered around their hospital and peripheral hospitals, from which patients were transferred. It is important to note that despite decreased rates of admissions and operations during the COVID-19 era as a result of implementing the guidelines, this trend can also be attributed to additional patient-related factors, such as patient apprehension to enter hospitals, misunderstanding of the new regulations, emotional and financial constraints, as well as preference for private facilities.[7]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 [Internet]. 2020 [Last cited on 2021 Mar 05].  Back to cited text no. 1
    
2.
Wallace CN, Kontoghiorghe C, Kayani B, Chang JS, Haddad FS. The impact of COVID-19 on trauma and orthopaedic surgery in the United Kingdom. Bone Jt Open 2020;1:420-3.  Back to cited text no. 2
    
3.
Dass D, Ramahamdany E, Govilkar S, Rhind JH, Ford D, Singh R, et al. How a pandemic changes trauma: Epidemiology and management of trauma admissions in the UK during COVID-19 lockdown. J Emerg Trauma Shock 2021;XX:XX-XX.  Back to cited text no. 3
    
4.
DiFazio LT, Curran T, Bilaniuk JW, Adams JM, Durling-Grover R, Kong K, et al. The impact of the COVID-19 pandemic on hospital admissions for trauma and acute care surgery. Am Surg 2020;86:901-3.  Back to cited text no. 4
    
5.
Forrester JD, Liou R, Knowlton LM, Jou RM, Spain DA. Impact of shelter-in-place order for COVID-19 on trauma activations: Santa Clara County, California, March 2020. Trauma Surg Acute Care Open 2020;5:e000505.  Back to cited text no. 5
    
6.
Placella G, Salvato D, Delmastro E, Bettinelli G, Salini V. CoViD-19 and ortho and trauma surgery: The Italian experience. Injury 2020;51:1403-5.  Back to cited text no. 6
    
7.
Wong JS, Cheung KM. Impact of COVID-19 on orthopaedic and trauma service: An epidemiological study. J Bone Joint Surg Am 2020;102:e80.  Back to cited text no. 7
    

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Correspondence Address:
Zoltan H Nemeth
Department of Surgery, Morristown Medical Center, Morristown, NJ; Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_18_21

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