Quality of care was not compromised during the COVID-19 pandemic at a level 1 trauma centre

Abstract

Background: The COVID-19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 adult major trauma service and a designated COVID-19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response.

Methods: The population of interest was all trauma patients captured in the hospital's trauma registry from 16 March 2016 to 10 September 2020. Regression modelling assessed changes in mechanism and severity of the injury, and mortality during two lockdowns compared with the proceeding 4 years. Cases were matched with hospital administrative databases to assess mean time from admission to emergency computed tomography (CT) scan, operating theatre, length of stay (LOS) and immediate surgery (OPSTAT).

Results: Throughout 2020, the hospital treated 525 COVID-19 patients. Compared with previous years, there was up to 34% reduction in major trauma and a 28% reduction in minor trauma admissions during the pandemic (p < 0.05). Intensive care unit admissions were almost half of predicted. Some of the largest reductions were seen in motor vehicle crashes (49%) and falls (28%) (p < 0.05). Time to CT, surgery and immediate surgery (OPSTAT) showed no change and having a suspected COVID-19 diagnosis did not prolong any of these times except for the LOS. Mortality was similar to previous years.

Conclusion: The COVID-19 pandemic has had widespread societal changes, resulting in a substantial decrease in trauma presentations. Despite COVID's immense impact on the hospital's trauma service, the quality of care was not impaired.

Keywords: COVID-19; emergency medicine; epidemiology; health services; public health.

Fig. 1

Weekly number of positive COVID‐19 cases in Victoria (blue line) and the corresponding weekly trauma presentations (major and minor) (orange bars and orange trend line) at the Royal Melbourne Hospital from 4 February to 14 September 2020. , Weekly trauma cases; , weekly COVID‐19 cases.

Fig. 2

Total number of trauma (minor and major) cases presenting to the Royal Melbourne Hospital during our three periods of interest: March to May (wave 1), May to July (transition) and July to September (wave 2), from 2016 to 2020. The blue vertical line indicates the time in between our periods of interest, and the black vertical line indicates the beginning of the first wave of COVID‐19 in Victoria and the onset of lockdown (16 March 2020). , Total trauma; , minor cases; , major cases.

Fig. 3

Minor (blue, ) and major (orange, ) trauma cases presenting to the Royal Melbourne Hospital during our three periods of interest: March to May (wave 1), May to July (transition) and July to September (wave 2). The number of expected (modelled from case numbers in 2016–2019) and observed cases in 2020 are shown, with the percent deviation from what was expected indicated in text in the observed columns.