The ICON Trauma Study: The Impact of the COVID-19 lockdown on Major Trauma workload in the UK

Adiamah, Alfred; Thompson, Amari; Lewis-Lloyd, Christopher; Dickson, Edward; Blackburn, Lauren; Moody, Nick; Gida, Sunil; La Valle, Angelo; Reilly, John-Joe; Saunders, John; Brooks, Adam

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 [less than] 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.

Citation

Adiamah, A., Thompson, A., Lewis-Lloyd, C., Dickson, E., Blackburn, L., Moody, N., …Brooks, A. (2021). The ICON Trauma Study: The Impact of the COVID-19 lockdown on Major Trauma workload in the UK. European Journal of Trauma and Emergency Surgery, 47, 637–645. https://doi.org/10.1007/s00068-020-01593-w

• Journal Article Type: Article
• Acceptance Date: Dec 27, 2020
• Online Publication Date: Feb 9, 2021
• Publication Date: Jun 1, 2021
• Deposit Date: Feb 8, 2021
• Publicly Available Date: Feb 9, 2021
• Journal: European Journal of Trauma and Emergency Surgery
• Print ISSN: 1863-9933
• Electronic ISSN: 1863-9941
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Pages: 637–645
• DOI: https://doi.org/10.1007/s00068-020-01593-w
• Keywords: Major trauma; Covid-19; Injury severity; Mortality; ICON-TRAUMA
• Public URL: https://nottingham-repository.worktribe.com/output/5311235
• Publisher URL: https://link.springer.com/article/10.1007/s00068-020-01593-w
• Additional Information: Authors on behalf of The ICON Trauma Study Group.