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[Do COVID-19 restrictions lead to a decrease in severely injured patients at a level 1 trauma center in Germany?]
Konrad F Fuchs1, Lars Eden2, Fabian Gilbert2
1Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland. fuchs_k5@ukw.de.
Insights
COVID-19 restrictions did not decrease the number of severely injured patients requiring intensive care. Trauma centers must maintain adequate capacity for critical injuries during health crises.
Area of Science:
- Trauma surgery
- Critical care medicine
- Public health policy
Background:
- Intensive care and ventilator capacity are critical for COVID-19 patient treatment.
- Severely injured patients often require prolonged intensive care and ventilation.
- The study investigated if COVID-19 restrictions impacted the number of severely injured patients and ICU capacity.
Purpose of the Study:
- To determine if COVID-19 related restrictions reduced the number of severely injured patients.
- To assess the impact on intensive care unit (ICU) capacity for trauma patients.
- To analyze changes in injury patterns and accident types during the pandemic.
Main Methods:
- Retrospective analysis of severely injured patients (ISS ≥16) from March 17 to April 30, 2020.
- Comparison with data from 2018 and 2019 as control groups.
- Recorded injury mechanisms, ISS, accident type (work-related, suicide attempt), and need for surgery within 24 hours.
Main Results:
- No significant difference in the total number of severely injured patients or those needing ICU/ventilator care.
- A slight increase in patients requiring surgery within 24 hours in 2020.
- A notable rise in work-related accidents (44.4% in 2020) and a decrease in non-work-related motorbike accidents.
Conclusions:
- COVID-19 restrictions did not reduce the demand for ICU care for severely injured patients.
- Trauma and critical care capacities must account for severely injured patients during crises.
- Further validation with the German Trauma Register is pending.
Background:
Intensive care and ventilator capacities are essential for treatment of COVID-19 patients. Severely injured patients are often in continuous need of intensive care and ventilator treatment. The question arises, whether restrictions related to COVID-19 have led to a decrease in severely injured patients and thus to an increase in intensive care unit (ICU) capacity.
Material And Methods:
A retrospective analysis of all seriously injured patients with an injury severity score (ISS) ≥16 was performed between 17 March and 30 April 2020 at a level 1 trauma center in Germany. The mechanism of injury and the ISS were recorded. Further data were collected as to whether it was a work-related accident, a documented suicide attempt and if surgery was necessary in the first 24 h after arrival in hospital. Data from 2018 and 2019 served as a control group.
Results:
There was no substantial difference in the total number of seriously injured patients (2018 n = 30, 2019 n = 23, 2020 n = 27). Furthermore, there was no relevant difference in the number of patients needing intensive care or ventilator treatment when leaving the shock room. The number of patients needing an operative intervention within the first 24 h after arriving at hospital was slightly higher in 2020. The mean ISS was at a constant level during all 3 years. In 2020 there was no polytraumatized motorbike rider, who did not have a work-related accident (2018 n = 5, 2019 n = 4, 2020 n = 0). A noticeable increase in work-related accidents was observed (2018: 10%, 2019: 26.1%, 2020 44.4%).
Discussion:
Restrictions related to COVID-19 did not lead to a reduction in seriously injured patients needing ICU care. Due to the monocentric data analysis there is room for misinterpretation. In general, intensive care and operating capacities should be managed with adequate consideration for seriously injured patients even in times of crisis, such as the COVID-19 pandemic. Confirmation through the German Trauma Register is pending.
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