Ruiz-Medina Pedro E, Ramos-Meléndez Ediel O, Cruz-De La Rosa Kerwin X, Arrieta-Alicea Antonio, Guerrios-Rivera Lourdes, Nieves-Plaza Mariely, Rodríguez-Ortiz Pablo
Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.
Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA.
Inj Epidemiol. 2021 Mar 22;8(1):22. doi: 10.1186/s40621-021-00324-y.
The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient's demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital.
An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 - June 15, 2020) with a control period (same period in 2017-2019). Comparisons were done using the Pearson's chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05.
A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31-0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS.
Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.
2019年冠状病毒病（COVID-19）大流行导致全球对社会活动进行限制，以遏制该疾病的传播。关于这些限制对创伤中心的影响，人们知之甚少。我们的目标是确定波多黎各创伤医院与大流行相关的封锁对创伤入院情况、患者人口统计学特征、损伤机制、损伤严重程度和结局的影响。
进行了一项经机构审查委员会（IRB）批准的准实验研究，通过比较封锁期间（2020年3月15日至2020年6月15日）与对照期（2017 - 2019年同期）的创伤入院情况来评估限制措施的影响。根据情况，使用Pearson卡方检验、Fisher精确检验或Mann-Whitney U检验进行比较。拟合负二项式模型以估计封锁前和封锁期间总体入院的发病率比。设定统计学显著性为p < 0.05。
2017年研究季度共有308名受试者入院；2018年为323名；2019年为347名；2020年为150名。与历史时期相比，封锁期间患者的年龄中位数（四分位间距）从40（33）岁显著升至49（30）岁（p < 0.001）。几乎所有损伤机制（即机动车事故、袭击、行人、烧伤、自杀未遂、其他）导致受伤患者的百分比都有轻微的非显著性下降。相反，在封锁期间跌倒的发生率有所增加（18.9%对26.7%；p = 0.026）。此外，以损伤严重程度评分（ISS）> 15衡量的重症病例比例下降（37.3%对26.8%；p = 0.014）；而比较组之间的住院时间中位数和死亡率没有差异。最后，在控制性别、年龄、损伤机制和ISS后，与封锁前相比，封锁期间总体入院人数的减少占59%（发病率比0.41；95%置信区间0.31 - 0.54）。
在经历社会隔离和宵禁后，创伤中心预计其总体患者数量将大幅减少，同时创伤模式也会发生相关变化。我们的研究结果将有助于为新的干预措施提供信息，并改善对未来或类似情况的医疗准备。
