The ICON Trauma Study: the impact of the COVID-19 lockdown on major trauma workload in the UK

Abstract Background The global pandemic caused by SARS-CoV-2 has impacted population health and care delivery worldwide. As information emerges regarding the impact of “lockdown measures” and changes to clinical practice worldwide; there is no comparative information emerging from the United Kingdom with regard to major trauma. Methods This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020–18/05/2020) to a historical cohort of patients admitted during a similar time period in 2019 (11/03/2019–20/05/2019). Differences in demographics, Clinical Frailty Scale, SARS-CoV-2 status, mechanism of injury and injury severity were compared using Fisher’s exact and Chi-squared tests. Univariable and multivariable logistic regression analyses examined the associated factors that predicted 30-days mortality. Results A total of 642 patients were included, with 405 in the 2019 and 237 in the 2020 cohorts, respectively. 4/237(1.69%) of patients in the 2020 cohort tested positive for SARS-CoV-2. There was a 41.5% decrease in the number of trauma admissions in 2020. This cohort was older (median 46 vs 40 years), had more comorbidities and were frail (p < 0.0015). There was a significant difference in mechanism of injury with a decrease in vehicle related trauma, but an increase in falls. There was a twofold increased risk of mortality in the 2020 cohort which in adjusted multivariable models, was explained by injury severity and frailty. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables. Conclusion Patients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality.

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664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK

British Journal of Surgery ◽

10.1093/bjs/znab134.074 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Adiamah ◽

A i Thompson ◽

C Lewis-Lloyd ◽

E Dickson ◽

L Blackburn ◽

...

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Multivariable Analysis ◽

Similar Time ◽

Historical Cohort ◽

Risk Of Mortality ◽

Major Trauma Centre ◽

Increased Risk ◽

Significant Difference ◽

The Impact

Abstract Introduction Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma. Method This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p < 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis. Conclusions Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

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Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre

Trauma ◽

10.1177/14604086211041271 ◽

2021 ◽

pp. 146040862110412

Author(s):

Aref-Ali Gharooni ◽

Fahim Anwar ◽

Romann Ramdeep ◽

Harry Mee

Keyword(s):

United Kingdom ◽

Major Trauma ◽

Injury Severity ◽

Trauma Centre ◽

Common Mechanism ◽

Mechanism Of Injury ◽

The United Kingdom ◽

Major Trauma Centre ◽

Limb Injuries ◽

Significant Difference

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups. Results 301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming < 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS ( p > 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury. Conclusion Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.

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1213 Cycling-related Trauma Admissions to the Major Trauma Centre in the Cycling Capital of the United Kingdom

British Journal of Surgery ◽

10.1093/bjs/znab259.1031 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Z Arshad ◽

M majeed ◽

A Thahir ◽

F Anwar ◽

J Rawal ◽

...

Keyword(s):

United Kingdom ◽

Major Trauma ◽

Injury Severity ◽

Trauma Centre ◽

Vehicle Group ◽

Mechanism Of Injury ◽

Helmet Use ◽

The United Kingdom ◽

Body Regions ◽

Major Trauma Centre

Abstract Aim The number of cyclists travelling on roads in the United Kingdom (UK) is increasing. The government has recently introduced initiatives to promote cycling uptake and so these numbers are likely to increase. This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK. Method A retrospective review of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. All patients were split into three groups based on the mechanism of injury. Our institution’s electronic patient record system was used to collect data including age, gender, mechanism of injury, Glasgow coma scale score on arrival, incident date and time, injured body regions, 30-day mortality, helmet use, and length of stay. Results A total of 606 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and longer hospital stay than the other two groups. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and higher GCS. Conclusions With a likely increase in future cycling uptake, it is crucial that effective interventions are put in place to improve the safety of cyclists. A multi-faceted strategy involving driver and cyclist education, road infrastructure changes and helmet promotion campaigns targeting the younger generation could be employed.

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The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men

Journal of Clinical Medicine ◽

10.3390/jcm8081263 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1263

Author(s):

Julian Joestl ◽

Nikolaus W. Lang ◽

Anne Kleiner ◽

Patrick Platzer ◽

Silke Aldrian

Keyword(s):

Trauma Center ◽

Major Trauma ◽

Injury Severity ◽

Demographic Data ◽

Term Outcome ◽

Long Term Outcome ◽

Hemodynamic Variables ◽

Significant Difference ◽

The Impact ◽

Icu Treatment

Purpose: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. Methods: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. Results: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. Conclusion: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.

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P9 Impact of the relocation of a regional neuroscience service on major trauma patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.89 ◽

2019 ◽

Vol 90 (3) ◽

pp. e28.2-e28

Author(s):

C Cabaret ◽

M Nelson ◽

M Foroughi

Keyword(s):

Major Trauma ◽

Strong Association ◽

Trauma Centre ◽

Trauma Patients ◽

Major Trauma Centre ◽

Significant Difference ◽

Ct Head ◽

The Mean ◽

The Impact ◽

Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

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Admission to a UK Major Trauma Centre following deliberate self-harm and attempted suicide: Prevalence and outcomes

Trauma ◽

10.1177/1460408619899596 ◽

2020 ◽

Vol 22 (4) ◽

pp. 285-294

Author(s):

Karen Hardwick ◽

Maggie Bellew

Keyword(s):

Suicide Attempt ◽

Major Trauma ◽

Injury Severity ◽

Suicide Attempts ◽

Trauma Centre ◽

Mechanism Of Injury ◽

Liaison Psychiatry ◽

Deliberate Self Harm ◽

Major Trauma Centre ◽

Self Harm

Background The incidence of suicide is increasing and for every suicide many more attempt it. Exploring such admissions to UK Major Trauma Centres improves our understanding. Methods Data on admissions to the Leeds Major Trauma Centre (2013–2016) following suicide attempts and acts of deliberate self-harm were obtained from the Trauma Audit and Research Network database. Retrospectively, quantitative and qualitative analyses were used to explore frequency of admissions, demographics, mechanism and severity of injury, outcomes, and input from the Clinical Psychology and Liaison Psychiatry services. Results A total of 192 admissions were identified; average age was 38.5 (SD: 16.1, range: 11–93), and 72% were male. The most frequent mechanism of injury was ‘fall/jump’ (41%, n = 78). A significant effect was found for gender and mechanism of injury (p = 0.025) with males using a wider range of methods, and females choosing ‘fall/jump’ most frequently. A total of 114 patients (59%) had an injury severity score >15. The suicide attempt was fatal for 34 patients (18%). A significant effect for mechanism of injury and mortality was found, with hanging most frequently, and stabbing least likely, to be fatal (p = 0.001). Twenty-six patients (13.5%) were seen by Clinical Psychology. In 2016, 82% of admissions (n = 37) were seen by Liaison Psychiatry with 33 referred onto other services. Eighteen (53%) had pre-existing mental health difficulties and/or evidence of substance misuse; 14 (38%) were recorded to have one or more previous suicide attempt. Average length of hospital stay was 15.2 days (SD: 26.8, range: 1–284) and the average cost £2958 (range: £195–£55,266). The average number of days in critical care was 2.9 (SD: 5.4, range: 0–29). Conclusions This study increased our understanding of deliberate self-harm/suicide attempts in the Leeds Major Trauma Centre. It indicated the high cost of deliberate self-harm/suicide attempts with the majority of patients having high injury severity score, and most surviving. Further research into follow-up and preventative support for this group of patients would be beneficial.

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Falls downstairs: The impact on a UK major trauma centre

Trauma ◽

10.1177/14604086211002989 ◽

2021 ◽

pp. 146040862110029

Author(s):

Joshua Callon ◽

Daniel Thomas ◽

Simon J Mercer

Keyword(s):

Older Patients ◽

Major Trauma ◽

Average Length ◽

Trauma Team ◽

Trauma Centre ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Younger Patients ◽

Major Trauma Centre ◽

The Impact

Introduction Major trauma centres are increasingly managing a significant injury burden in older patients, with falling downstairs being a prevalent mechanism of injury. Literature evaluating the impact of falls on stairs upon UK trauma networks is limited. Gaining a greater understanding of this may allow for more effective planning of services and improvements in training and education. This study evaluates the impact of falls downstairs on a UK major trauma centre. Methods A single centre retrospective service evaluation of local major trauma data over a 3-year period from 01/01/2017 to 31/12/2019. Included were patients who activated a trauma call whose mechanism of injury recorded at the time of admission was a fall downstairs. We excluded patients less than 16 years of age. Results There were 4480 major trauma patients who presented in the study period and of these, 860 (19.2%) sustained injuries following a fall downstairs. The most common age group presenting was 70–79 years; younger patients (<60 years) made up 43.3% with the majority (56.7%) being older. All but one patient were managed by a consultant-led trauma team, 6.4% of patients were admitted to critical care and 1% received an urgent operation. The overall mortality rate was 8.5%. Older patients made up 85% of those who died and had nearly four times longer average length of stay than younger patients (9.69 v 2.49 days). Conclusion Falls downstairs place a significant burden on the major trauma centre. There is a stark contrast in the use of hospital resources and outcomes between older and younger patients.

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Impact of pretreatment anemia on upfront abiraterone acetate therapy for metastatic hormone-sensitive prostate cancer: a multicenter retrospective study

BMC Cancer ◽

10.1186/s12885-021-08206-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Teppei Okamoto ◽

Daisuke Noro ◽

Shingo Hatakeyama ◽

Shintaro Narita ◽

Koji Mitsuzuka ◽

...

Keyword(s):

Prostate Cancer ◽

Prognostic Factor ◽

Abiraterone Acetate ◽

Tumor Burden ◽

Hazard Ratio ◽

Historical Cohort ◽

High Tumor Burden ◽

Significant Difference ◽

Hormone Sensitive ◽

The Impact

Abstract Background Anemia has been a known prognostic factor in metastatic hormone-sensitive prostate cancer (mHSPC). We therefore examined the effect of anemia on the efficacy of upfront abiraterone acetate (ABI) in patients with mHSPC. Methods We retrospectively evaluated 66 mHSPC patients with high tumor burden who received upfront ABI between 2018 and 2020 (upfront ABI group). We divided these patients into two groups: the anemia-ABI group (hemoglobin < 13.0 g/dL, n = 20) and the non-anemia-ABI group (n = 46). The primary objective was to examine the impact of anemia on the progression-free survival (PFS; clinical progression or PC death before development of castration resistant PC) of patients in the upfront ABI group. Secondary objectives included an evaluation of the prognostic significance of upfront ABI and a comparison with a historical cohort (131 mHSPC patients with high tumor burden who received androgen deprivation therapy (ADT/complete androgen blockade [CAB] group) between 2014 and 2019). Results We found that the anemia-ABI group had a significantly shorter PFS than the non-anemia-ABI group. A multivariate Cox regression analysis showed that anemia was an independent prognostic factor of PFS in the upfront ABI group (hazard ratio, 4.66; P = 0.014). Patients in the non-anemia-ABI group were determined to have a significantly longer PFS than those in the non-anemia-ADT/CAB group (n = 68) (P < 0.001). However, no significant difference was observed in the PFS between patients in the anemia-ABI and the anemia-ADT/CAB groups (n = 63). Multivariate analyses showed that upfront ABI could significantly prolong the PFS of patients without anemia (hazard ratio, 0.17; P < 0.001), whereas ABI did not prolong the PFS of patients with anemia. Conclusion Pretreatment anemia was a prognostic factor among mHSPC patients who received upfront ABI. Although the upfront ABI significantly improved the PFS of mHSPC patients without anemia, its efficacy in patients with anemia might be limited.

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Impact of Weight-Band Dosing of Tinzaparin for Venous Thromboembolism Prophylaxis on Persistent Wound Drainage in Adult Patients Undergoing Hip and Knee Arthroplasty

Annals of Pharmacotherapy ◽

10.1177/10600280211024294 ◽

2021 ◽

pp. 106002802110242

Author(s):

Cassandra Cooper ◽

Ouida Antle ◽

Jennifer Lowerison ◽

Deonne Dersch-Mills ◽

Ashley Kenny

Keyword(s):

Body Weight ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Thromboembolism Prophylaxis ◽

Wound Drainage ◽

Increased Risk ◽

Significant Difference ◽

The Impact

Background: Persistent wound drainage and venous thromboembolism (VTE) are potential complications of total joint arthroplasty, and these risks can be challenging to balance in clinical practice. Anecdotal observation has suggested that following joint arthroplasty, persistent wound drainage occurs more frequently with higher body weight and higher doses of tinzaparin when compared with lower body weight and lower doses of tinzaparin. Objective: The overall purpose of this study was to describe the impact of a tinzaparin weight-band dosing table for VTE prophylaxis on wound healing, thrombosis, and bleeding outcomes in patients undergoing total joint arthroplasty. Methods: This retrospective chart review included patients who underwent total hip or knee arthroplasty and received tinzaparin for thromboprophylaxis per their weight-banding category. The primary outcome was the incidence of persistent wound drainage. Secondary outcomes include the occurrence of VTE and clinically important bleeding during hospital admission. Results: A total of 231 patients were included in the analysis. There was no significant difference in persistent wound drainage between the 3 weight categories, and there were no differences in rates of VTE or clinically important bleeding. Concurrent use of low-dose acetylsalicylic acid was associated with a 3-fold increased risk of persistent wound drainage (risk ratio = 3.35; 95% CI = 2.14-5.24; P = 0.00003). Conclusion and Relevance: In joint arthroplasty patients, we observed no significant difference in rates of persistent wound drainage between various weight categories receiving different weight-banded doses of tinzaparin. Our results do not suggest that the current weight-band dosing table for tinzaparin needs to be adjusted to optimize patient outcomes.

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The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

Fetal Diagnosis and Therapy ◽

10.1159/000509245 ◽

2020 ◽

Vol 47 (12) ◽

pp. 865-872 ◽

Cited By ~ 1

Author(s):

Natalie E. Rintoul ◽

Roberta L. Keller ◽

William F. Walsh ◽

Pamela K. Burrows ◽

Elizabeth A. Thom ◽

...

Keyword(s):

New England ◽

Gestational Age ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Outcome Data ◽

Neonatal Outcomes ◽

Increased Risk ◽

Significant Difference ◽

The Impact ◽

Prenatal Surgery

Introduction: The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in The New England Journal of Medicine in 2011. Objective: Neonatal outcomes for the complete trial cohort (N = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. Methods: Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. Results: Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. Conclusion: The benefits of prenatal surgery outweigh the complications of prematurity.

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