P-EGS12 An observational study investigating the differences the COVID-19 Pandemic had on admissions, methods of injury in a tertiary trauma centre in a major UK City

Abstract Background During March 2020 the country was plunged into a nationwide lockdown. Despite this, there remained a steady stream of trauma admissions. COVID changed a lot about how many medical specialties worked and we wanted to explore the effects on our patient population, and compare it to the experience of other hospitals. Methods We analysed existing data on admissions to the Emergency Department that were referred to the trauma service between the 12th of March to the 24th of May; encompassing the lockdown and the two weeks either side. This data was compared to that of the year beforehand. We compared ages, sexes, mortality, methods of injury, and disposition. Results Admissions fell, 193, compared to 271 (∼3:1 M:F). Both cohorts featured more younger people, but there was a drop-off in the number of older folk post-COVID; 6 of 9 centiles of the over 60s showed a fall in admissions of at least 14%. Those admitted to the Major Trauma service (ISS 9+) remained the same. Regarding the methods of injury, the most common presentations remained road traffic accidents, stabbings and falls <1m, contributing to 71 and 72% total admissions before and after COVID respectively. However, there were fewer patients falling from heights of > 2m (OR 0.5), and fewer recorded assaults (OR 4.0). Penetrating injuries were separated into “stabbings” and “others”. There was a significant increase in non-stabbing penetrating injuries (OR 4.6), a majority of which were self-inflicted. The rate of self harm during the lockdown showed a similar increase, from featuring in 8% of total presentations to 15% of admissions (OR 1.87). The hospital restructured considerably between the sample dates such that dispositions are not possible to compare meaningfully. Rates of patients sent straight home from the ED were similar (OR 1.0). Conclusions Overall, the lockdown had a moderate impact on patient numbers and demography. The data implies that the measures did small amounts to deter people from the roads and from interacting with each other in assaults and stabbings. Older people were less likely to present traumatically. The isolation may have led to a masking of mental health issues leading to a significant increase in self harm, which may present opportunities for restructuring of services in any the event of further major lockdowns. These conclusions are limited by the data, and next steps would include gathering more detailed mortality data.

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118 Trauma in COVID-19: A comparison analysis of trauma calls at a Major Trauma Centre in the UK during the CoVID pandemic restrictions

British Journal of Surgery ◽

10.1093/bjs/znab259.440 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Naseem ◽

J Lee

Keyword(s):

Major Trauma ◽

Road Traffic ◽

Fold Increase ◽

Trauma Centre ◽

Trauma Patients ◽

Deliberate Self Harm ◽

Trauma Service ◽

Major Trauma Centre ◽

Self Harm ◽

The Uk

Abstract Aim Varying restrictions placed on the UK public to manage the COVID-19 Pandemic impacted on the day-to-day lives of most people and changed the presentation and nature of trauma presenting at our UK Major Trauma Centre. Trauma activity during the November and March 2020 lockdown periods were compared and the changes in trauma activity were used to inform workforce planning. During the most restrictive period, March 2020, trauma activity initially decreased compared with 6 weeks preceding lockdown, before returning and then exceeding beyond pre-lockdown levels. Method Prospective data was collected for all ED trauma calls and regional referrals to the Major Trauma Service. We compared the initial 27-day lockdown periods in November to March 2020; specifically comparing trends in code red calls, silver trauma, road traffic collisions and injuries resulting from deliberate self-harm. Results There were a similar number of RTCs (18 vs 16) in both periods. There was a 28% increase in the number of trauma calls (103 vs 80), and a 4-fold increase in Code RED calls (8 vs 2) and injuries due to deliberate self-harm (8 vs 2). There were almost double the number of silver trauma patients. Interestingly, there was a 30% decrease in alcohol related trauma alerts. Conclusions Our results reflected the level of restrictions in place; a higher incidence of trauma calls including code reds and RTCs in November. The higher incidence of self-harm noticed in the second lockdown may reflect the psychological impact of the pandemic and change in restrictions over time.

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A retrospective analysis of twenty two cases of floating knee

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202688 ◽

2020 ◽

Vol 6 (4) ◽

pp. 797

Author(s):

Umesh Yadav ◽

Ajay Sheoran ◽

Mayank Dutta ◽

Ashish Devgan ◽

Amit Dahiya ◽

...

Keyword(s):

Functional Assessment ◽

Knee Injury ◽

Traffic Accidents ◽

Road Traffic ◽

Damage Control ◽

Tertiary Care ◽

Knee Injuries ◽

Trauma Centre ◽

Tertiary Care Centre ◽

Floating Knee Injury

Background: With increase in road traffic accidents, incidence of floating knee injuries is increasing day by day. Along with bony injuries, multiorgan injuries are generally present which require urgent intervention. Despite advance in surgical management and implants, achieving a good functional knee still remains a challenge to the surgeons.Methods: This retrospective study was conducted to assess management, functional outcome and complications of patient presenting with floating knee injury to a tertiary care centre. 22 patients with floating knee injury admitted in trauma centre from 2017 to 2019 were analysed and functional assessment was done.Results: Males with mean age 33.5 years were exclusively victims of road traffic accident. 14 patients presented with multisystem injury. After stabilization fractures were fixed with nails/plates/screws. Knee stiffness was most common complication seen in 37% cases. Functional assessment was done using modified Karlstrom Olerud criteria which revealed excellent results in 22.7% cases while poor results in 18.2% cases.Conclusions:Floating knee injury is not merely bony injury but a multisystem injury and should be managed on principles of Damage control Orthopaedics. Regarding bony injuries, achieving union and acceptable range of motion remains the prime target.

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Time Series Analysis for Assessing and Forecasting of Road Traffic Accidents - Case Studies

WSEAS TRANSACTIONS ON MATHEMATICS ◽

10.37394/23206.2020.19.17 ◽

2020 ◽

Vol 19 ◽

Keyword(s):

Time Series ◽

Case Studies ◽

Traffic Accidents ◽

Road Traffic ◽

Public Health Problem ◽

Road Traffic Accidents ◽

The Road ◽

Before And After ◽

The Uk ◽

Serious Injuries

Road traffic accident is one of the main causes of injuries and fatalities worldwide, serious injuries and mortality in road collisions being a public health problem. The paper gives a overview of time series modeling and forecasting with application in road traffic injuries monitoring. After presenting of the main models and the methodological issues used in Box-Jenkins approach, the paper discusses two case studies, using a multiplicative SARIMA model and an intervention model, for a time series representing the number of mortal traffic accidents in USA, and the road traffic accidents with death and serious injuries in the UK, before and after the imposition of the Arabian embargo in November 1973.

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40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0068.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 330-338 ◽

Cited By ~ 1

Author(s):

Bisola Ajayi ◽

Alex Trompeter ◽

Magnus Arnander ◽

Philip Sedgwick ◽

Darren F. Lui

Keyword(s):

Clinical Characteristics ◽

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Group A ◽

Group B ◽

The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

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40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0068.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 330-338 ◽

Cited By ~ 2

Author(s):

Bisola Ajayi ◽

Alex Trompeter ◽

Magnus Arnander ◽

Philip Sedgwick ◽

Darren F. Lui

Keyword(s):

Clinical Characteristics ◽

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Group A ◽

Group B ◽

The Uk

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Comparison of trauma management between two major trauma services in Riyadh, Kingdom of Saudi Arabia and Melbourne, Australia

BMJ Open ◽

10.1136/bmjopen-2020-045902 ◽

2021 ◽

Vol 11 (5) ◽

pp. e045902

Author(s):

Mohammad Alsenani ◽

Faisal A Alaklobi ◽

Jane Ford ◽

Arul Earnest ◽

Waleed Hashem ◽

...

Keyword(s):

Saudi Arabia ◽

Length Of Stay ◽

Major Trauma ◽

Road Traffic ◽

Binary Logistic Regression ◽

Trauma Centre ◽

Hospital Death ◽

Inpatient Mortality ◽

Kingdom Of Saudi Arabia ◽

Trauma Service

IntroductionThe burden of injury in the Kingdom of Saudi Arabia (KSA) has increased in recent years, but the country has lacked a consistent methodology for collecting injury data. A trauma registry has been established at a large public hospital in Riyadh from which these data are now available.ObjectivesWe aimed to provide an overview of trauma epidemiology by reviewing the first calendar year of data collection for the registry. Risk-adjusted analyses were performed to benchmark outcomes with a large Australian major trauma service in Melbourne. The findings are the first to report the trauma profile from a centre in the KSA and compare outcomes with an international level I trauma centre.MethodsThis was an observational study using records with injury dates in 2018 from the registries at both hospitals. Demographics, processes and outcomes were extracted, as were baseline characteristics. Risk-adjusted endpoints were inpatient mortality and length of stay. Binary logistic regression was used to measure the association between site and inpatient mortality.ResultsA total of 2436 and 4069 records were registered on the Riyadh and Melbourne databases, respectively. There were proportionally more men in the Saudi cohort than the Australian cohort (86% to 69%). The Saudi cohort was younger, the median age being 36 years compared with 50 years, with 51% of injuries caused by road traffic incidents. The risk-adjusted length of stay was 4.4 days less at the Melbourne hospital (95% CI 3.95 days to 4.86 days, p<0.001). The odds of in-hospital death were also less (OR 0.25; 95% CI 0.15 to 0.43, p<0.001).ConclusionsThis is the first hospital-based study of trauma in the kingdom that benchmarks with an individual international centre. There are limitations to interpreting the comparisons, however the findings have established a baseline for measuring continuous improvement in outcomes for KSA trauma services.

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A profile of a major trauma centre of North West England between 2011 and 2018

Scientific Reports ◽

10.1038/s41598-021-84266-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Raimundas Lunevicius ◽

Mina Mesri

Keyword(s):

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Survival Rates ◽

Trauma Team ◽

Trauma Centre ◽

North West ◽

Major Trauma Centre ◽

Mortality Ratio ◽

Expected Mortality

AbstractThis study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. The number of trauma team activations (TTAs) rose sharply over time (n = 699 in 2013; n = 1522 in 2018). The proportion of TTAs that involved MT patients decreased from 75.1% in 2013 to 67.4% in 2018. The leading cause of MT was a fall from less than 2 m (36%). There has been a fivefold increase in the overall number of trauma procedures between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons. Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The observed mortality rates exceeded that of expected rates in years 2012, 2014, 2016 and 2017. The all-cause observed to expected mortality ratio was 1.08 between 2012 and 2018. A change in care for MT patients was not directly associated with improved survival, although the marginally ascending trend line in survival rates between 2012 and 2018 reflects a gradual positive change.

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Patient profiles of below knee-amputation following road traffic accidents – An observational study from a level 1 trauma centre in India

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.10.014 ◽

2020 ◽

Author(s):

Uttam Chand Saini ◽

Aman Hooda ◽

Sameer Aggarwal ◽

Mandeep Singh Dhillon

Keyword(s):

Observational Study ◽

Traffic Accidents ◽

Road Traffic ◽

Trauma Centre ◽

Road Traffic Accidents ◽

Knee Amputation ◽

Patient Profiles ◽

Level 1

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The Epidemiology of Injuries in Adults in Nepal: Findings from a Hospital-Based Injury Surveillance Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312701 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12701

Author(s):

Santosh Bhatta ◽

Dan Magnus ◽

Julie Mytton ◽

Elisha Joshi ◽

Sumiksha Bhatta ◽

...

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Injury Surveillance ◽

Prospective Surveillance ◽

Senior Managers ◽

Number Of Patients ◽

Common Causes ◽

Self Harm ◽

One Year ◽

Injured Patients

This study aimed to develop and evaluate a model of hospital-based injury surveillance and describe the epidemiology of injuries in adults. One-year prospective surveillance was conducted in two hospitals in Hetauda, Nepal. Data were collected electronically for patients presenting to emergency departments (EDs) with injuries between April 2019 and March 2020. To evaluate the model’s sustainability, clinical leaders, senior managers, data collectors, and study coordinators were interviewed. The total number of patients with injuries over one year was 10,154, representing 30.7% of all patients visiting the EDs. Of patients with injuries, 7458 (73.4%) were adults aged 18 years and over. Most injuries (6434, 86%) were unintentional, with smaller proportions due to assault (616, 8.2%) and self-harm (408, 5.5%). The median age of adult patients was 33 years (IQR 25–47). Males had twice the rate of ED presentation compared with females (40.4 vs. 20.9/1000). The most common causes were road traffic accidents (32.8%), falls (25.4%), and animal/insect related injuries (20.1%). Most injured patients were discharged after treatment (80%) with 9.1% admitted to hospital, 8.1% transferred to other hospitals, and 2.1% died. In Nepal, hospital-based injury surveillance is feasible, and rich injury data can be obtained by embedding data collectors in EDs.

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Analysis of Penetrating Neck Injuries (PNIs) at a South London Trauma Centre before and after the first national lockdown.

10.22541/au.163612383.31626913/v1 ◽

2021 ◽

Author(s):

Gabriela Di Scenza ◽

Katrina Mason ◽

Georgios Oikonomou

Keyword(s):

Psychiatric Care ◽

Trauma Centre ◽

Neck Injuries ◽

Bodily Harm ◽

Grievous Bodily Harm ◽

Co Morbidity ◽

Before And After ◽

Self Harm ◽

Over Time ◽

Health Diagnosis

•A 28-month retrospective review from February 2019 to April 2021 of penetrating neck injuries (PNIs) at our trauma centre revealed a 48% (n=25 to n=37) increase in PNIs ‘post-lockdown’ (lockdown date = 23rd March 2020). •The aetiology of PNI changed over time, with an increase in the proportion of Deliberate Self Harm’ (DSH) cases from 1/3 to 2/3rds of case (n=9 to n=25), an overall 177.8% increase ‘post-lockdown’. An increase in mortality was also seen with no deaths ‘pre-lockdown’, and 3 deaths ‘post-lockdown’. •‘Accidental Injuries’ (AI) increased from 4% to 10% of cases (n=1 to n=4) post lockdown, with ‘grievous bodily harm (GBH) reducing from half to 1/5th of all cases (n=13 to n=8), and ‘domestic violence’ from 8% of cases to no cases post lockdown (DV) ‘post lockdown’. •‘Pre-lockdown’ 10% of DSH patients (n=1) were noted to have a prior mental health diagnosis or psychiatric care, ‘post-lockdown’ this increased to 61.5% (n=16) of DSH patients. •Data from our tertiary trauma centre in London has shown a change in aetiology, psychiatric co-morbidity and number of PNIs pre and post lockdown.

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