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Observational Study
. 2022 Feb 1;275(2):252-258.
doi: 10.1097/SLA.0000000000005300.

The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study

Mitchell L S Driessen  1 , Leontien M Sturms  1 , Frank W Bloemers  2 , Henk Jan Ten Duis  3 , Michael J R Edwards  4 , Dennis den Hartog  5 , E J Kuipers  1 , Peter A Leenhouts  2 , Martijn Poeze  6 , Inger B Schipper  7 , Richard W Spanjersberg  8 , Klaus W Wendt  9 , Ralph J de Wit  10 , Stefan W A M van Zutphen  11 , Mariska A C de Jongh  12 , Luke P H Leenen  13
Affiliations
Observational Study

The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study

Mitchell L S Driessen et al. Ann Surg. .

Abstract

Objective: To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands.

Summary background data: Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome.

Methods: A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period).

Results: During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012).

Conclusions: The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Dutch national intensive care bed occupancy for an 11-week period from March 8 to May 31, 2020.
FIGURE 2
FIGURE 2
The weekly number of major trauma patients and the number of major trauma patients directly admitted to the ICU or operating room (OP) during the COVID-19 peak and reference periods.
FIGURE 3
FIGURE 3
Major trauma patients expected and observed mortality during the first COVID-19 peak in 2020 and the reference periods in 2018 and 2019.
See this image and copyright information in PMC

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