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Multicenter Study
. 2021 Jul 19;16(1):39.
doi: 10.1186/s13017-021-00383-y.

Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Riccardo Giudici  1 , Armando Lancioni  2 , Hedwige Gay  2 , Gabriele Bassi  1 , Osvaldo Chiara  3 , Claudio Mare  4 , Nicola Latronico  5   6 , Antonio Pesenti  7 , Roberto Faccincani  8 , Luca Cabrini  9 , Roberto Fumagalli  1   10 , Arturo Chieregato  11 , Laura Briani  12 , Fabrizio Sammartano  13 , Giuseppe Sechi  4 , Alberto Zoli  4 , Andrea Pagliosa  4 , Giuseppe Foti  14 , Erika Borotto  15 , Alessandra Palo  16 , Oliviero Valoti  17 , Marco Botteri  18 , Michele Carlucci  19 , Elisa Reitano  20 , Roberto Bini  12
Affiliations
Multicenter Study

Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Riccardo Giudici et al. World J Emerg Surg. .

Abstract

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.

Keywords: COVID-19; Emergency; Trauma; Trauma care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trends of different mechanisms of trauma in the two compared periods
See this image and copyright information in PMC

References

    1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy. Early experience and forecast during an emergency response. JAMA. 2020;323(16):1545–1546. doi: 10.1001/jama.2020.4031. - DOI - PubMed
    1. Chiara O, Mazzali C, Lelli S, Mariani A, Cimbanassi S. A population based study of hospitalized seriously injured in a region of northern Italy. World J Emerg Surg. 2013;8(1):32–42. doi: 10.1186/1749-7922-8-32. - DOI - PMC - PubMed
    1. Bank M. O’Neill P, Prince J, Simon R, Teperman S, Winchell R. Early report from the greater New York chapter of the American College of Surgeons Committee on Trauma on the COVID-19 crisis. 2020.
    1. Ringdal KG, Coats TJ, Lefering R, Di Bartolomeo S, Steen PA, Røise O, et al. The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med. 2008;16(1):7. doi: 10.1186/1757-7241-16-7. - DOI - PMC - PubMed
    1. Bouzat P, Ageron FX, Brun J, Levrat A, Berthet M, Rancurel E, et al. A regional system to optimize the pre-hospital triage of trauma patients. Critical Care. 2015;19(1):111–120. doi: 10.1186/s13054-015-0835-7. - DOI - PMC - PubMed

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