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Open Access 01-12-2021 | Triage | Research article

Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Authors: Riccardo Giudici, Armando Lancioni, Hedwige Gay, Gabriele Bassi, Osvaldo Chiara, Claudio Mare, Nicola Latronico, Antonio Pesenti, Roberto Faccincani, Luca Cabrini, Roberto Fumagalli, Arturo Chieregato, Laura Briani, Fabrizio Sammartano, Giuseppe Sechi, Alberto Zoli, Andrea Pagliosa, Giuseppe Foti, Erika Borotto, Alessandra Palo, Oliviero Valoti, Marco Botteri, Michele Carlucci, Elisa Reitano, Roberto Bini

Published in: World Journal of Emergency Surgery | Issue 1/2021

Abstract

Backgrounds

The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods.

Methods

A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography.

Results

During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001).

Conclusions

The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

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Title: Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry
Authors: Riccardo Giudici
Armando Lancioni
Hedwige Gay
Gabriele Bassi
Osvaldo Chiara
Claudio Mare
Nicola Latronico
Antonio Pesenti
Roberto Faccincani
Luca Cabrini
Roberto Fumagalli
Arturo Chieregato
Laura Briani
Fabrizio Sammartano
Giuseppe Sechi
Alberto Zoli
Andrea Pagliosa
Giuseppe Foti
Erika Borotto
Alessandra Palo
Oliviero Valoti
Marco Botteri
Michele Carlucci
Elisa Reitano
Roberto Bini
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Triage
Care
COVID-19
Published in: World Journal of Emergency Surgery / Issue 1/2021
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-021-00383-y

At a glance: The STEP trials

Springer Medicine

Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Abstract

Backgrounds

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Backgrounds

Methods

Results

Conclusions

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