Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population
2.3. Data Collection and Analysis
3. Results
3.1. Differences in Demographic and Clinical Characteristics between Groups
3.2. Differences in Clinical Outcomes between Groups
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Jang, J.Y.; Shim, H.; Kim, J.H.; Hong, S.-K.; Bae, K.S. Current status of the Korean acute care surgery system for non-traumatic ab-dominal emergency surgery: A single-regional trauma center study. J. Korean Med. Assoc. 2019, 62, 130–134. [Google Scholar] [CrossRef]
- Seo, E.-W.; IM, J. A Review of Quality Management and Improvement of Trauma Fee Schedule in Regional Trauma Center. Health Policy Manag. 2021, 31, 399–408. [Google Scholar]
- Kim, K.; Kim, Y. Analysis of Characteristics of Thoracic Injury Patients and Nursing Interventions Using Nursing Intervention Classification by Emergency Room Type. J. Korean Biol. Nurs. Sci. 2021, 23, 257–266. [Google Scholar] [CrossRef]
- Haam, J.-H.; Hur, Y.-I.; Kim, Y.-S.; Kim, K.-K.; Kang, J.-H.; Ko, H.-J.; Cho, Y.J.; Choi, H.-I.; Lee, K.R.; Park, J.H.; et al. Fatty Liver Change in Korean Adults in a Systematic Social Distancing System Amid the COVID-19 Pandemic: A Multicenter Analysis. Int. J. Environ. Res. Public Health 2022, 19, 10444. [Google Scholar] [CrossRef] [PubMed]
- Walton, M.; Murray, E.; Christian, M.D. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur. Heart J. Acute Cardiovasc. Care 2020, 9, 241–247. [Google Scholar] [CrossRef]
- Lee, S.H. Mental Health Impacts in Health Care Workers during the COVID-19 Pandemic. J. Korean Neuropsychiatr. Assoc. 2021, 60, 19–22. [Google Scholar] [CrossRef]
- Park, C.; Sugand, K.; Nathwani, D.; Bhattacharya, R.; Sarraf, K.M. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: The “golden month” The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative. Acta Orthop. 2020, 91, 556–561. [Google Scholar] [CrossRef]
- Staunton, P.; Gibbons, J.P.; Keogh, P.; Curtin, P.; Cashman, J.P.; O’Byrne, J.M. Regional trauma patterns during the COVID-19 pan-demic. Surgeon 2021, 19, e49–e52. [Google Scholar] [CrossRef]
- Kim, M.J.; Yang, K.M.; Lim, H. Epidemiology of Facial Bone Fractures during the Coronavirus Disease 2019 Pandemic: A Single Korean Level I Trauma Center Study. J. Trauma Inj. 2021, 34, 233–241. [Google Scholar] [CrossRef]
- Kim, S.H.; Ryu, D.; Kim, H.; Lee, K.; Jeon, C.H.; Choi, H.J.; Jang, J.H.; Kim, J.H.; Yeom, S.R. Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Outcomes among Patients with Polytrauma at a Single Regional Trauma Center in South Korea. J. Trauma Inj. 2021, 34, 155–161. [Google Scholar] [CrossRef]
- Chang, Y.R.; Kim, K.M.; Kim, H.J.; Kim, D.H.; Kim, J.; Noh, D.; Ma, D.S.; Yun, J.; Yun, J.-H.; Lee, S.W.; et al. Impacts of Social Distancing during the COVID-19 Outbreaks in Korea: Level 1 Trauma Center Data of Domestic Incidents and Intentional Injury. Osong Public Health Res. Perspect. 2020, 11, 345–350. [Google Scholar] [CrossRef] [PubMed]
- Park, J.; Jung, K.; Kwon, J.; Moon, J.; Huh, Y.; Heo, Y.J.; Kang, B.H. Changes in the characteristics of trauma patients after the early COVID-19 outbreak: A retrospective study of a regional level 1 trauma center in Republic of Korea. Medicine 2022, 101, e2856. [Google Scholar] [CrossRef]
- Coimbra, R.; Edwards, S.; Kurihara, H.; Bass, G.A.; Balogh, Z.J.; Tilsed, J.; Faccincani, R.; Carlucci, M.; Casas, I.M.; Gaarder, C.; et al. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur. J. Trauma Emerg. Surg. 2020, 46, 505–510. [Google Scholar] [CrossRef] [PubMed]
- Maleitzke, T.; Pumberger, M.; Gerlach, U.A.; Herrmann, C.; Slagman, A.; Henriksen, L.S.; von Mauchenheim, F.; Hüttermann, N.; Santos, A.N.; Fleckenstein, F.N.; et al. Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany. PLoS ONE 2021, 16, e0246956. [Google Scholar] [CrossRef]
- Cluver, L.; Lachman, J.M.; Sherr, L.; Wessels, I.; Krug, E.; Rakotomalala, S.; Blight, S.; Hillis, S.; Bachman, G.; Green, O.; et al. Parenting in a time of COVID-19. Lancet 2020, 395, e64. [Google Scholar] [CrossRef] [PubMed]
- Bradbury-Jones, C.; Isham, L. The pandemic paradox: The consequences of COVID-19 on domestic violence. J. Clin. Nurs. 2020, 29, 2047–2049. [Google Scholar] [CrossRef] [Green Version]
- Hatchimonji, J.S.; Swendiman, R.A.; Seamon, M.J.; Nance, M.L. Trauma does not quarantine: Violence during the COVID-19 pan-demic. Ann. Surg. 2020, 272, e53. [Google Scholar] [CrossRef]
- Pfefferbaum, B.; North, C.S. Mental Health and the COVID-19 Pandemic. N. Engl. J. Med. 2020, 383, 510–512. [Google Scholar] [CrossRef]
- Freeman, L.; Fothergill-Bourbonnais, F.; Rashotte, J. The experience of being a trauma nurse: A phenomenological study. Intensiv. Crit. Care Nurs. 2014, 30, 6–12. [Google Scholar] [CrossRef]
- Sherman, W.F.M.; Khadra, H.S.M.; Kale, N.N.B.; Wu, V.J.; Gladden, P.B.; Lee, O.C. How Did the Number and Type of Injuries in Patients Presenting to a Regional Level I Trauma Center Change during the COVID-19 Pandemic with a Stay-at-home Order? Clin. Orthop. Relat. Res. 2020, 479, 266–275. [Google Scholar] [CrossRef]
- Badach, J.M.; Platoff, R.; Rattigan, D.; Butts, C.A.; Shea, L.; Gaughan, J.P.; Hunter, K.; Sifri, Z.; Porter, J.; Egodage, T. Trauma Incidence during the New Jersey COVID-19 Stay-at-Home Order: A Multicenter Study. J. Surg. Res. 2022, 284, 264–268. [Google Scholar] [CrossRef] [PubMed]
- Sheets, N.W.; Fawibe, O.S.; Mahmoud, A.; Chawla-Kondal, B.; Ayutyanont, N.; Plurad, D.S. Impact of the COVID-19 Pandemic on Trauma Encounters. Am. Surg. 2021, 89, 434–439. [Google Scholar] [CrossRef] [PubMed]
- Kim, W.S.; Cho, M.S.; Bae, K.S.; Kang, S.J.; Lee, K.H.; Hwang, K.; Oh, J.R.; Park, I.H. Clinical analysis of death in trauma patients. J. Trauma Inj. 2007, 20, 96–100. [Google Scholar]
- Lefering, R.; Paffrath, T.; Bouamra, O.; Coats, T.J.; Woodford, M.; Jenks, T.; Wafaisade, A.; Nienaber, U.; Lecky, F. Epidemiology of in-hospital trauma deaths. Eur. J. Trauma Emerg. Surg. 2012, 38, 3–9. [Google Scholar] [CrossRef] [PubMed]
Variable | Categories | Total (n = 4585) | Pre COVID-19 (n = 2396) | Post COVID-19 (n = 2189) | x2, t (p) |
---|---|---|---|---|---|
n (%), M ± SD | n (%), M ± SD | n (%), M ± SD | |||
Age (year) | 58.30 ± 18.65 | 57.60 ± 18.55 | 59.06 ± 18.73 | −2.659 (0.008) | |
<65 | 2835 (61.8) | 1526 (63.7) | 1309 (59.8) | 7.336 (0.007) | |
≥65 | 1750 (38.2) | 870 (36.3) | 880 (40.2) | ||
Gender | Male | 2807 (61.2) | 1451 (60.6) | 1356 (61.9) | 0.927 (0.336) |
Female | 1778 (38.8) | 945 (39.4) | 833 (38.1) | ||
Admission route | Direct | 3144 (68.6) | 1610 (67.2) | 1534 (70.1) | 4.410 (0.036) |
Transfer in | 1441 (31.4) | 786 (32.8) | 655 (29.9) | ||
Trauma type | Accident | 4332 (94.5) | 2285 (95.4) | 2047 (93.5) | 7.703 (0.021) |
Suicide | 140 (3.1) | 63 (2.6) | 77 (3.5) | ||
Violence | 113 (2.5) | 48 (2.0) | 65 (3.0) | ||
Injury mechanism | In car TA | 482 (10.5) | 272 (11.4) | 210 (9.6) | 3.762 (0.052) |
Bicycle | 134 (2.9) | 65 (2.7) | 69 (3.2) | 0.778 (0.378) | |
Motorbike | 358 (7.8) | 188 (7.8) | 170 (7.8) | 0.010 (0.919) | |
Other transportation | 85 (1.9) | 54 (2.3) | 31 (1.4) | 4.411 (0.036) | |
Pedestrian TA | 439 (9.6) | 250 (10.4) | 189 (8.6) | 4.281 (0.039) | |
Fall down | 873 (19.0) | 460 (19.2) | 413 (18.9) | 0.082 (0.775) | |
Slip down | 1459 (31.8) | 716 (29.9) | 743 (33.9) | 8.688 (0.003) | |
Struck | 305 (6.7) | 160 (6.7) | 145 (6.6) | 0.005 (0.942) | |
Penetrating | 218 (4.8) | 116 (4.8) | 102 (4.7) | 0.083 (0.773) | |
Mental status | Alert | 3813 (83.2) | 1984 (82.8) | 1829 (83.6) | 1.733 (0.630) |
Verbal | 327 (7.1) | 168 (7.0) | 159 (7.3) | ||
Pain | 255 (5.6) | 143 (6.0) | 112 (5.1) | ||
Unresponsive | 190 (4.1) | 101 (4.2) | 89 (4.1) | ||
ISS | <9 | 1765 (38.5) | 989 (41.3) | 776 (35.4) | 16.855 (0.001) |
9–15 | 1765 (38.5) | 879 (36.7) | 886 (40.5) | ||
16–24 | 602 (13.1) | 296 (12.4) | 306 (14.0) | ||
≥25 | 453 (9.9) | 232 (9.7) | 221 (10.1) | ||
RTS | 7.654 ± 0.6280 | 7.6464 ± 0.6458 | 7.6642 ± 0.6080 | −0.931 (0.352) | |
GCS | 14.28 ± 0.03 | 14.27 ± 2.60 | 14.29 ± 2.28 | −0.178 (0.858) | |
Vital signs | sBP (mm/Hg) | 142.77 ± 30.96 | 142.50 ± 30.69 | 143.07 ± 31.25 | −0.615 (0.538) |
≤90 | 185 (4.1) | 97 (4.1) | 88 (4.1) | 0.003 (0.954) | |
>90 | 4311 (95.9) | 2251 (95.9) | 2060 (95.9) | ||
PR (rate/min) | 86.90 ± 18.32 | 86.89 ± 18.06 | 86.91 ± 18.60 | −0.043 (0.966) |
Variable | Categories | Total (n = 4585) | Pre COVID-19 (n = 2396) | Post COVID-19 (n = 2189) | x2, t (p) |
---|---|---|---|---|---|
Transfusion | pRBC < 24 h unit, mean ± SD | 5.07 ± 6.66 | 5.36 ± 6.20 | 4.75 ± 7.14 | 1.186 (0.236) |
pRBC > 10 unit/day n (%) | 85 (12.7) | 56 (16.0) | 29 (9.2) | 6.869 (0.009) | |
ER stay time(min) | mean ± SD | 250.4 ± 176.1 | 253.5 ± 171.0 | 247.0 ± 181.4 | 1.233 (0.218) |
<90, n (%) | 652 (14.2) | 265 (40.6) | 387 (59.4) | 41.088 (<0.001) | |
≥91, n (%) | 3933 (85.8) | 2131 (54.2) | 1802 (45.8) | ||
ER outcome n (%) | Send to ward | 2847 (62.1) | 1493 (62.3) | 1354 (62.1) | 0.533 (0.912) |
Send to ICU | 1152 (25.1) | 605 (25.3) | 547 (25.0) | ||
Send to OR | 523 (11.4) | 266 (11.1) | 257 (11.7) | ||
Death | 63 (1.4) | 32 (1.3) | 31 (1.4) | ||
Time to OR | Minutes, mean ± SD | 136.41 ± 107.31 | 140.24 ± 113.42 | 132.44 ± 100.66 | 0.831 (0.406) |
Mortality n (%) | Death | 274 (6.0) | 142 (5.9) | 132 (6.0) | 0.022 (0.882) |
Survival | 4311 (94.0) | 2254 (94.1) | 2057 (94.0) | ||
LOH (days) | mean ± SD | 14.59 ± 16.91 | 14.63 ± 18.10 | 14.55 ± 15.50 | 0.172 (0.863) |
Variable | Categories | Total (n = 4585) | Pre COVID-19 (n = 2396) | Post COVID-19 (n = 2189) | x2 (p) |
---|---|---|---|---|---|
Complications | AKI | 66 (1.4) | 17 (0.7) | 49 (2.2) | 18.848 (<0.001) |
ARDS | 7 (0.2) | 2 (0.1) | 5 (0.2) | 1.576 (0.209) | |
Surgical wound infection | 53 (1.2) | 20 (0.8) | 33 (1.5) | 4.532 (0.033) | |
DVT | 42 (0.9) | 12 (0.5) | 30 (1.4) | 9.532 (0.002) | |
Pneumonia | 130 (2.8) | 56 (2.3) | 74 (3.4) | 4.520 (0.034) | |
PTE | 14 (0.3) | 3 (0.1) | 11 (0.5) | 5.350 (0.021) | |
UTI | 46 (1.0) | 13 (0.5) | 33 (1.5) | 10.725 (0.001) | |
CRBSI | 12 (0.3) | 7 (0.3) | 5 (0.2) | 0.178 (0.673) | |
Sever sepsis | 20 (0.4) | 4 (0.2) | 16 (0.7) | 8.378 (0.004) |
Variables | Odds Ratio | 95% Confidence Interval | p-Value |
---|---|---|---|
Post-COVID-19 | 1.81 | 1.3–2.5 | <0.001 |
Age ≥ 65 | 2.39 | 1.7–3.37 | <0.001 |
Male | 1.75 | 1.21–2.54 | 0.003 |
Lowest SBP | 1.47 | 0.84–2.57 | 0.177 |
Transfusion | 1.503 | 0.99–2.28 | 0.055 |
ISS | 1.08 | 1.06–1.1 | <0.001 |
ER stay time | 0.999 | 0.998–1 | 0.136 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Jang, M.; Lee, M.; Lee, G.; Lee, J.; Choi, K.; Yu, B. Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study. Healthcare 2023, 11, 1074. https://doi.org/10.3390/healthcare11081074
Jang M, Lee M, Lee G, Lee J, Choi K, Yu B. Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study. Healthcare. 2023; 11(8):1074. https://doi.org/10.3390/healthcare11081074
Chicago/Turabian StyleJang, Myungjin, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, and Byungchul Yu. 2023. "Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study" Healthcare 11, no. 8: 1074. https://doi.org/10.3390/healthcare11081074