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Rod Little Prize Papers
1427 The effect of the COVID-19 pandemic on major trauma presentations and patient outcomes in English hospitals
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  1. Carl Marincowitz1,
  2. Omar Bouamra2,
  3. Tim Coates3,
  4. Dhushy Kumar4,
  5. David Lockey5,
  6. Virginia Newcombe6,
  7. Lyndon Mason7,
  8. David Yates2,
  9. Julian Thompson8,
  10. Fiona Lecky9
  1. 1University of Sheffield
  2. 2TARN
  3. 3TARN and University of Leicester
  4. 4Department of Critical Care, Anaesthesia and Pre-hospital Emergency Medicine, University Hospital Coventry
  5. 5London Air Ambulance, Royal London Hospital, North Bristol NHS Trust
  6. 6Division of Anaesthesia, University of Cambridge
  7. 7Liverpool University Hospitals NHS Foundation Trust, University of Liverpool
  8. 8Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital Intensive Care Unit
  9. 9TARN and University of Sheffield

Abstract

Aims, Objectives and Background There is evidence that COVID-19 ‘lockdowns’ may have contributed to increased non-accidental injury, domestic violence and self-harm related to deteriorating mental health. Internationally, there is also evidence that the diversion of health care resources may led to worse outcomes for patients presenting with major trauma. There has been no previous national evaluation of ‘lockdown’ measures impact on the characteristics, treatment pathways and outcomes of trauma patients in England

We aimed to assess the impact of successive lockdowns on the volume, demographics, injury mechanism, severity, treatment and outcomes of major trauma in England.

Method and Design Demographic characteristics and clinical pathways of TARN eligible patients in the first lockdown (24th March to 3rd July 2020 inclusive) and second lock down (1st November 2020 to 16th May 2021 inclusive) were compared to equivalent pre-COVID-19 periods in 2018–2019.

A segmented regression model predicting the weekly risk adjusted survival was estimated and a discontinuity in the gradient (trend) or intercept (level) of the fitted model was tested for at the weekly time point of implementation of each lockdown.

Abstract 1427 Figure 1
Abstract 1427 Figure 1

Strobe diagram for inclusion of study population

Abstract 1427 Figure 2
Abstract 1427 Figure 2

Interrupted time series analysis assessing the impact of COVID restrictions on likelihood of survival (red horizontal lines indicate introduction and relaxation of ‘lockdown’ measures)

View this table:
Abstract 1427 Table 1

Comparison of demographics ‘lockdown’ and pre-COVID periods

View this table:
Abstract 1427 Table 2

Comparison care pathways ‘lockdown’ and pre-COVID periods

Results and Conclusion The first ‘lockdown’ had a larger associated reduction in total trauma volume (-21%) compared to the pre-COVID period than the second ‘lockdown’ (-6.7%). Trauma volume increased for those 65 and over (3%) and 85 and over (9.3%) during the second ‘lockdown’.

There was a reduction in likelihood of survival (-1.71; 95% CI:-2.76 to -0.66) associated with the immediate introduction of the first ‘lockdown’. However, this was followed by a trend of improving survival (0.25; 95% CI: 0.14 to 0.35) and likelihood of survival returned to pre-pandemic levels by the end of the first ‘lockdown’ period.

Future research is needed understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first ‘lockdown’ to prevent this occurring if measures re-introduced.

http://dx.doi.org/10.1136/emermed-2022-RCEM2.2

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