1427 The effect of the COVID-19 pandemic on major trauma presentations and patient outcomes in English hospitals

Aims, Objectives and Background There is evidence that COVID-19 ‘lockdowns’ may have contributed to increased non-accidental injury, domestic violence self-harm related deteriorating mental health. Internationally, there also the diversion of health care resources led worse outcomes for patients presenting with major trauma. has been no previous national evaluation ‘lockdown’ measures impact on characteristics, treatment pathways trauma in England We aimed assess successive lockdowns volume, demographics, injury mechanism, severity, England. Method Design Demographic characteristics clinical TARN eligible first lockdown (24th March 3rd July 2020 inclusive) second lock down (1st November 16th May 2021 were compared equivalent pre-COVID-19 periods 2018–2019. A segmented regression model predicting weekly risk adjusted survival was estimated a discontinuity gradient (trend) or intercept (level) fitted tested at time point implementation each lockdown. Abstract 1427 Figure 1 Strobe diagram inclusion study population 2 Interrupted series analysis assessing COVID restrictions likelihood (red horizontal lines indicate introduction relaxation measures) Table Comparison demographics pre-COVID Period 24Mar19 – 03Jul19 (comparator) 24Mar20 03Jul20 (lockdown 1) Absolute change [percentage (95%CI)] p-value 01Nov18 16May19 01Nov20 16May21 Total 22243 17510 -4733 (-21%) p<0.0001‡ 41016 38262 2754 (–6.7%) Age (years), Median (IQR) 67.6 (46.5–83.1) 70.9 (50.3–84.2) 3.3 (2.4 4.2)p<0.0001 69.1 (48.7–83.6) 73.1 (53.3–85.1) 4 (3.5 4.2)<0.0001 bands, n(%) Age< 138 (0.6%) 130 (0.7%) -8 [0.1(-0.04 0.030)] p=0.14 281 234 -47 [0.1 (-0.2 0.04)]p=0.1979 <16 942 (4.2%) 674 (3.8%) -268 [-0.4 (-0.8 0]p=0.0531 1444 (3.5%) 1218 (3.2%) -226 [-0.3(-0.6 0.1)p=0.0084 16 64 9561 (43%) 6974 (39.8%) -2587 [-3.2(-4.1 -2.2)P<0.0001 17173 (41.9%) 13980 (36.5%) -3193 [-5.3(-6 -5)]p<0.0001 65 over 11740 (52.8%) 9862 (56.3%) -1878 [3.5 (2.5 4.5)]p<0.0001 22399 (54.6%) 23064 (60.3%) 665 [5.7(5 6.3)]P<0.0001 85 4610 (20.7%) 4047 (23.1%) -563 [2.4(1.6 3.2)]p<0.0001 8903 (21.7%) 9731 (25.4%) 828 [3.7 (3.1 4.3)]p<0.0001 Male, 12316 (55.4%) 9512 (54.3%) -2804 [-1 (-2 -0.6)]p=0.0373 22146 (54%) 19769 (51.7%) -2377 [-2.3 (-3 -1.6)]<0.0001 CCI*, CCI 0 9359 (42.1%) 6220 (35.5%) -3139 [ -6.5 (-7.5 -5.6)] p<0.0001 16665 (40.6%) 12806 (33.5%) -3859 [-7.1(-7.8 -6.5)]p<0.0001 5 8538 (38.4%) 6896 (39.4%) -1642 [1 (0.3 2)]p=0.0426 15899 (38.8%) 15667 (40.9%) -232 [2.2 (1.5 2.9)]p<0.0001 6 10 3032 (13.6%) 3061 (17.5%) 29 [3.8 (3.2 4.6)]p<0.0001 5987 (14.6%) 6863 (17.9%) 876 [3.3(2.8 3.8)]p<0.0001 > 927 1024 (5.8%) 97 [1.7(1.2 2.1)]p<0.0001 1648 (4%) 2410 (6.3%) 762 [2.3(2 2.6)]p<0.0001 Not recorded 387 (1.7%) 309 (1.8%) -88 [0.2 0.3)]p=0.8513 817 (2%) 516 (1.3%) -301 [-0.6(-0.8 -0.5)]p<0.0001 MOI**: RTC, Car occupant 1247 (30.7%) 551 (20.4%) -696 [-10.4(-12.4 -8.2)]p<0.0001 2485 (35.2%) 1551 (31.3%) -934 [-3.9(-5.6 -2.2)]p<0.0001 Pedestrian 661 (16.3%) 288 (10.6%) -373 [-5.6 (-7.2 -4)]p<0.0001 1629 962 (19.4%) -667 [-3.7(-5.1 Motorcycles 1196 (29.4%) 711 (26.3%) -485 [-3.2(-5.3 -1)]p<0.0001 1524 (21.6%) 976 (19.7%) -548[ -1.9(-3.3 -0.4)]p<0.0001 Cyclist 912 (22.4%) 1139 227 [19.6(17.4 21.9)]p<0.0001 1315 (18.6%) 1396 (28.2%) 81 [9.5(8 11.1)]p<0.0001 Other 11 (0.3%) <9 () -10 -0.2(-0.4 -0.06)p=0.0251 31 (0.4%) (0.2%) -21 [-0.23(-0.4 -0.04)]p=0.0281 MOI: Intentional, Intentional assault 88 (0.5%) -42 [-0.08 0.06)]p=0.2724 175 -52 [-0.1(-0.2 0.002)]P=0.0570 Self harm 276 (1.2%) 284 (1.6%) 8 [0.4 (0.1 0.6)]p=0.0014 525 562 (1.5%) 37 (0.02 0.3)]p=0.0223 NAI 63 27 -36 -0.03)]p=0.0072 90 -7 [-0.001(-0.07 0.07)]p=0.9701 Shooting 34 40 [0.08(-0.01 0.2)]p=0.0826 80 56 (0.1%) -24 -0.05(-0.1 0.001)]p=0.0979 Stabbing 450 312 -138 [-0.2(-0.5 0.03)]p=0.0816 791 (1.9%) 589 -202 (-0.6 -0.2)]p<0.0001 Blows 1174 (5.3%) 647 (3.7%) -527 [-1.6(-1.9 -1.2)]p<0.0001 2059 (5%) 1299 (3.4%) -760 -1.3)]p<0.0001 Unintentional, Falls>2m 2055 (9.2%) 1757 (10%) -298 [0.8(0.2 1.4)]P=0.0075 3740 (9,1%) 3528 -212 [0.1(-0.3 0.5)]p=0.6181 Falls<2m 13384 (60.2%) 11314 (64.6%) -2070 [4.4 5.4)]p<0.0001 25505 (62.2%) 26203 (65.8%) 698 [6.3 (5.6 6.9)]p<0.0001 Sport 449 320 -129 [-0.2 (-0.5 0.01]p=0.1697 615 489 -126 (-0.4 -0.006)]p=0.0079 GCS bands , Mild 19609 (88.2%) 15449 4160 0.7)]p=0.8264 35831 (87.4%) 34051 (89%) -1780 [1.6 (1.2 Moderate 689 (3.1%) 625 (3.6%) -64 [0.5(0.1 0.8)]p=0.0090 1333 1127 (2.9%) -206 [-0.3 -0.06)]p=0.0135 Severe 955 (4.3%) 765 (4.4%) -190 (-0.3 0.5)]p=0.7136 1886 (4.6%) 1464 -422 [-0.8(-1 990 (4.5%) 671 -319 -0.6(-1 -0.2)]p=0.0022 1966 (4.8%) 1620 -346 -0.3)]p=0.0002 ISS***, median 9 (9–18) (9–17) ISS 4545 3062 -1483 [-3 (-4 -2)]p=<0.0001 8266 (20.2%) 7838 (20.5%) -428 [0.3(-0.2 0.9)]p=0.2457 15 9290 (41.8%) 7728 (44.1%) -1562 [2.4(1.4 3.3)]p<0.0001 17207 (42%) 16969 (44.3%) -233 [2.4(1.7 3.1)]p<0.0001 >15 8408 (37.8%) 6720 -1688 [5.6(-0.4 1.5)]p=0.2391 15543 (37.9%) 13455 -2088 [-2.7 (-3.4 -2)]p<0.0001 >25 3995 (18%) 3127 -868 [-0.1(-0.9 0.7 )]p=0.7921 7521 (18.3%) 6201 (16.2%) -1320 [-2.1(-2.6 -1.6)]p<0.0001 Body regions, Head AIS 3+ 5911 (26.6%) 4670 (26.7%) -1241 1)]p=0.8301 11128 (27.1%) 9629 (25.2%) -1499 -2(-2.6 Face 41 -22 [-0.05 (-0.1 0.05)]p=0.3416 99 69 -30 [-0.06 0)]p=0.0618 Chest 4787 (21.5%) 3915 -872 [8.3 (0.2 1.6)]<0.0450 8515 (20.8%) 8075 (21.1%) -440 [0.3 0.9)]p=0.2337 Abdomen 872 (3.9%) 690 -182 [0.02 0.4)]p=0.9177 1465 1179 -286 [-0.5 (-0.7 -0.2)]p=0.0001 Spine 1985 (8.9%) 1561 -424 [-0.01(-0.6 0.5)]p=0.9744 3784 3459 (9%) -325 [-0.2(-0.6 0.2)]p=0.3654 Pelvis 758 600 -158 [0.02(-0.3 0.4)]p=0.9184 1501 1386 -115 [-0.04(-0.3 0.2)]p=0.7802 Limb 5707 (25.7%) 4892 (27.9%) -815 [2.3 (1.4 10719 (26.1%) 10122 (26.5%) -597 [0.3(-0.3 0.9)]p=0.3053 217 (1%) 199 (1.1%) -18 (-0.04 0.3)]p=0.1176 375 (0.9%) 396 21 (-0.01 0.2]p=0.0836 Polytrauma 1622 (7.3%) 1350 (7.7%) -272 0.9)]p=0.1160 2984 2429 -555 [-0.9(-1.2 0.6)]p<0.0001 *CCI Charlson Comorbidity Index **MOI Mechanism ***ISS Injury Severity Score ‡ chi square test uniform distribution Change 2) st Hospital MTC 9908 (44.5%) 7376 -2532 [-2.4 -1.4)]p<0.0001 18099 15928 (41.6%) -2171 [-2.5 (-3.2 -1.8)]p<0.0001 Treated 11176 (50.2%) 8256 (47.2%) -2920 20395 (49.7%) 17852 (46.7%) -2543[-3 -2.4)]p<0.0001 Consultant ED 8140 (36.6%) 5562 (31.8%) -2578 [-4.8(-5.8 -3.9)]p<0.0001 14779 (36%) 12577 (32.9%) -2202 [-3.2 (-3.8 -2.5)]p<0.0001 CT within hr 5062 (31.9%) 3992 (30.9%) -1070 [-0.9(-2 0.1)]p=0.0944 9203 (31.6%) 7776 -1427 [-4(-5 -3.7)]p<0.0001 Whole body 3348 (15.1%) 3210 [3 (2 4)]p<0.0001 6040 (14.7%) 6417 (16.8%) 377 [2 2.5)]p<0.0001 ICU stay 3092 (13.9%) 2208 (12.6%) -884 [-1.3(-1.9 -0.6) ]p=0.0002 5591 3850 (10.1%) -1741 [-3.6(-4 -3)]p<0.0001 Mortality* 1417 (7.1%) 1316 (8.3%) -101 [1.2 (0.6 1.7)]p<0.0001 2916 (7.9%) 2858 (8.1%) -58 0.6)] p=0.2040 Discharge destination, Home (own) 13800 (62%) 10484 (59.9%) -3316 [-2(-3.1 24961 (60.9%) 23368 (61.1%) -1593 [-0.7 (-1.4 -0.05)]p=0.0340 (relative/carer) 473 (2.1%) 372 [0 0.3)]p=0.9890 974 (2.4%) 852 (2.2%) -122 [-0.1(-0.4 0.06)]p=0.1653 Mortuary* (6.7%) 1323 (7.6%) -178 [0.8(0.3 1.3)]p=0.0019 3086 (7.5%) 2977 (7.8%) -109 0.5)]p=0.5113 No fixed abode 75 47 -28 (-37.3%) 107 87 -20 (-18.7%) Known 39 -48 (-55.2%) 101 95 -6 (-5.9%) Nursing 1190 1063 (6.1%) -127 [0.7(0.3 1.2)]p=0.0020 2448 (6%) 2231 -217 0.1)]p=0.1620 Acute hospital 2425 (10.9%) 1736 (9.9%) -689 [-0.1(-1.6 -0.4)]p=0.0014 4346 3313 (8.7%) -1033 [-0.1(-0.5 0.2)]p=0.4115 institution 526 [0.6 0.9)]p=0.0003 980 870 (2.3%) -110 [-0.1 0.1)]p=0.2817 Rehabilitation 2077 (9.3%) 1871 (10.7%) [1.3(0.7 1.9)]p<0.0001 3851 (9.4%) 4274 (11.2%) 423 1.7(1.3 2.2)]p<0.0001 Social 50 -13 0.1)]p=0.9657 121 103 [-0.2(-0.1 0.5)]p=0.4939 *These totals do not correspond as mortality includes deaths community censored 30 days Results Conclusion The had larger associated reduction total volume period than (-6.7%). Trauma those (3%) during ‘lockdown’. (-1.71; 95% CI:-2.76 -0.66) immediate However, this followed by trend improving (0.25; CI: 0.14 0.35) returned pre-pandemic levels end period. Future research needed understand initial after observed prevent occurring if re-introduced.