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

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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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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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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Vascular injuries and Their Management in Major Trauma from Road Traffic Collisions at a Major Trauma Centre

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1230 ◽

2019 ◽

Vol 58 (6) ◽

pp. e536-e537

Author(s):

Rachael Bygate ◽

Laurence Orchard ◽

Michelle Wilkinson ◽

Raghvinder Gambhir

Keyword(s):

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Vascular Injuries ◽

Major Trauma Centre

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598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown

British Journal of Surgery ◽

10.1093/bjs/znab259.471 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Payne ◽

E Campbell ◽

T Welman ◽

G Pahal ◽

S Myers

Keyword(s):

Plastic Surgery ◽

Major Trauma ◽

Healthcare Delivery ◽

Total Body Surface Area ◽

Trauma Centre ◽

Control Group ◽

Major Trauma Centre ◽

The Government ◽

The Uk ◽

Surgery Department

Abstract Aim The COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period. Method Retrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed. Results Fifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes. Conclusions Despite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.

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1651 Improving Surgical Admission Clerking in A Major Trauma Centre – The Role of a Standardised Clerking Proforma

British Journal of Surgery ◽

10.1093/bjs/znab259.784 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Arnaouti ◽

M Foxall-Smith ◽

D Mittapalli

Keyword(s):

Major Trauma ◽

Service Evaluation ◽

Trauma Centre ◽

P Value ◽

Medication History ◽

Allied Health Professionals ◽

Essential Information ◽

Major Trauma Centre ◽

Good Patient Care ◽

The Uk

Abstract Introduction High quality medical records are integral to Good Medical Practice in the UK, for provision of good patient care. This study assesses the effectiveness of a structured Surgical Assessment Proforma in improving documentation, within the Surgical Assessment Unit (SAU) of a major trauma centre. Method A four-phase prospective study was undertaken – using PDSA methodology. This included: initial clinician survey and proforma development, audit, re-audit post-implementation, and final user survey. Evaluation and proforma design utilised standards from the RCS(Eng) and the PRSB. Notes of all patients admitted to the SAU, over two separate one-week periods, were assessed for completeness of documentation. Statistical analysis employed T-Test, with a P value of < 0.05 considered significant. The study was considered service evaluation, and therefore exempt from ethical approval. Results Pre-Proforma Survey 100% of respondents felt a proforma would be beneficial. 77% believed key elements of clerking were missed within the previous system. Cycle 1 (n = 62) Of note, assessment categories lacking information were: Responsible Consultant, Medication History, Allergy Status and Differential Diagnosis. Cycle 2 (n = 119) Of 45 assessment criteria: 38 improved (23 significantly (P < 0.05)), 2 showed no change, 5 were reduced (2 significantly (P < 0.05)). Documentation rates in nine categories improved by over 50%. Post-Proforma Survey 73% of doctors and 86% of allied health professionals (AHPs) agreed documentation improved with proforma use. 66% of clinicians agreed proformas reduced omission of essential information and provided safe clerking guidance for doctors. 100% of AHPs agreed the proforma improved handover. Conclusions In a major trauma centre SAU, standardised proforma use improves completeness of clerking.

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Traumatic aortic injury presenting to an adult major trauma centre

Trauma ◽

10.1177/1460408618773547 ◽

2018 ◽

Vol 21 (4) ◽

pp. 272-279

Author(s):

Jordan Bade-Boon ◽

Joseph K Mathew ◽

Mark C Fitzgerald ◽

Biswadev Mitra

Keyword(s):

Clinical Characteristics ◽

Road Traffic ◽

Clinical Signs ◽

Vital Signs ◽

High Energy ◽

Aortic Injury ◽

Trauma Centre ◽

Road Traffic Crashes ◽

Major Trauma Centre ◽

Rule Out

Introduction Traumatic aortic injury is an uncommon condition. Timely diagnosis may enable early haemostatic resuscitation, essential to prevent worsening of the injury prior to definitive management. The aim of this study was to assess the utility of initial vital signs and presenting clinical characteristics to confirm or rule out aortic injury. Methods A retrospective review of patients from The Alfred Trauma Registry was conducted. Patients presenting between January 2006 and July 2014 and diagnosed with aortic injury were identified. Demographics and presenting clinical characteristics were extracted. Sensitivity of individual clinical variables for the detection of aortic injury was calculated. Results There were 77 patients identified with aortic injury, with an in-hospital mortality rate of 19.5% (95% CI: 10.6–28.3%). Of these, 68 (88.3%) patients presented after high-energy blunt mechanisms. Clinical signs and early chest X-ray findings were poorly sensitive to detect aortic injury. Patients who presented with hypotension had a greater severity of aortic injury, more commonly had associated abnormal investigation findings and were more likely to require blood products and inotropic agents (p < 0.05). However, sensitivity of initial hypotension to rule out aortic injury was 39.0% (95% CI: 28.1–49.9%). Conclusions The diagnosis of aortic injury was uncommon in hospital. Most injuries were secondary to high-velocity road traffic crashes or high falls. Clinical signs were not adequately sensitive to be used for the exclusion of aortic injury. We recommend a high degree of clinical suspicion and liberal imaging among cases where aortic injury is possible.

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The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases

Bone & Joint Open ◽

10.1302/2633-1462.15.bjo-2020-0028.r1 ◽

2020 ◽

Vol 1 (5) ◽

pp. 137-143 ◽

Cited By ~ 13

Author(s):

Matthew Hampton ◽

Matthew Clark ◽

Ian Baxter ◽

Richard Stevens ◽

Elinor Flatt ◽

...

Keyword(s):

Major Trauma ◽

Fragility Fractures ◽

Trauma Centre ◽

Hand Injuries ◽

Orthopaedic Trauma ◽

Nerve Injuries ◽

Number Of Patients ◽

Major Trauma Centre ◽

The Uk ◽

The Impact

Aims The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. Methods Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. Results There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). Conclusion The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.

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1665 Characterising the Escalation in Hospital Trauma Admission During the Easing of the COVID-19 Level 4 Lockdown Restrictions

British Journal of Surgery ◽

10.1093/bjs/znab259.1065 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Holt ◽

A Sud ◽

G Dixon ◽

O Rutka ◽

J Taylor

Keyword(s):

Service Provision ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Major Trauma Centre ◽

Severity Scores ◽

Tier System ◽

Societal Level ◽

Level 1 ◽

Trauma Admission

Abstract Introduction Major trauma reduced by over a third during the institution of UK level-4 national lockdown (Rajput K. et al; 2020). Easing of lockdown on a societal level posed unprecedented uncertainties. With the easing of restrictions, it is expected that the quantity of trauma would increase. In the absence of ‘normality’ it remains uncertain about the extent of the quantity, severity and aetiology of the trauma. The effect of lockdown easing on patterns of traumatic admissions has not been studied and it has important implications upon service provision. Method A retrospective cohort study using the data from 2017-2019 were used as a 3-year control to compare each month of 2020. Regional trauma data (TARN data) from Aintree level-1 Major Trauma Centre, the regional tertiary Specialist Units. Easing of restrictions to the regional tier system began in May-July. This index 3months was compared to the control data. Results Following easing of restrictions there was a significant increase in the Incident Severity Scores from trauma admissions. The %mortality during the level-4 lockdown decreases but as restrictions are eased there is an increase in the % mortality. The number of stabbings and road traffic collisions are also seen to increase following the ease of restrictions. Conclusions There is a decrease in the number of trauma calls seen following the easing of restrictions, yet the severity of the incident and the mortality rate has increased. Therefore, is the trauma more severe of does COVID-19 influence this?

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