key: cord-0691955-z1s3g5m2
authors: Seehra, J K; Lewis-Lloyd, C; Gida, G; Adiamah, A; Brooks, A
title: Impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the East Midlands Major Trauma Centre: An ICON Trauma Study
date: 2021-03-16
journal: Br J Surg
DOI: 10.1093/bjs/znab014
sha: 6f0078dc4ea3d9a881ed40e9d0718e9e670fd5d1
doc_id: 691955
cord_uid: z1s3g5m2

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(StataCorp, College Station TX, USA). Variables included demographics, time to CT and surgery, management approaches, and operative characteristics. Data normality was assessed by visualizing distribution plots, with non-parametric data presented as median (i.q.r.) values. Statistical comparison was undertaken using Mann-Whitney U, Fisher's exact and v 2 tests as appropriate, and P <0.050 was deemed statistically significant.

Of 642 patients, 405 were admitted in 2019 and 237 in 2020, representing a 41.5 per cent absolute reduction in trauma admissions during the COVID-19 period ( Table 1) . No statistical differences were noted between arrival in the emergency department and time to CT, with a median of 42 minutes from admission. Within subgroup analysis of surgical patients, there were significant differences in the time to surgery(P ¼ 0.019) and duration of surgery (P ¼ 0.014). We found a 31.2 per cent increase in patients operated on within 24 hours of admission and a 42.9 per cent reduction in surgery lasting more than 120 minutes during the COVID-19 pandemic. There was more than a twofold increase in night-time operations occurring between 22.00 and 08.00 hours during COVID-19. No differences in type or time of surgery, surgical approach or level of postoperative care were observed. The EM-MTC was able to make early preparations in 2020, anticipating the expected disruptions of COVID-19. The present results show a significant reduction in major trauma admissions, similar to observations reported elsewhere 5 . Interestingly, there was no difference in time to radiological imaging when 2020 was compared with 2019. This was achieved by streamlining CT scanning for COVID-suspected and non-suspected patients, and facilitated by having two CT rooms within the emergency department and 24-hour reporting availability.

Overall, during the COVID-19 pandemic, most medical and surgical specialties reported a decreased workload. In addition, there was a curtailing of the elective workload to free up bed availability for patients with COVID-19 6 . The unintended beneficial consequence from a trauma perspective was the prompt availability of theatre spaces and personnel, potentially explaining the shorter duration to surgical intervention during the 2020 period. Additionally, the presence of a 24hour dedicated trauma surgeon, supported by senior surgical trainees, encouraged single-stage definitive operations with a shift towards quicker surgical technique. Importantly, having this dedicated workforce ensured more operations were undertaken overnight (22.00 to 08.00 hours) during the COVID-19 period than in 2019.

Early robust restructuring of staff, space and services in the COVID-19 period allowed the EM-MTC to maintain excellence in patient care. Improvements to the major trauma pathway have 

Reflections from London's level-1 major trauma centres during the COVID crisis

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Major Trauma Dashboard

ICON Trauma (Impact of COVID-19 on Major Trauma workload) study

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services