key: cord-0863217-xfdce0is
authors: Williams, Nicole; Winters, Jackie; Cooksey, Rebecca
title: Staying home but not out of trouble: no reduction in presentations to the South Australian paediatric major trauma service despite the COVID‐19 pandemic
date: 2020-08-15
journal: ANZ J Surg
DOI: 10.1111/ans.16277
sha: 6f47dd1f0d1f0e77d8799932e244ef3784ffbc06
doc_id: 863217
cord_uid: xfdce0is

nan

Digital Innovation, Forest Hill, MD, USA, prior to 2018: Microsoft Access). In order to understand the effects on trauma during the COVID-19 pandemic period in a jurisdiction without a strict "lockdown", following Human Research Ethics Committee approval, we reviewed our trauma database for presentations from 00:00 hours on 23 rd March 2020 until 23:59 hours on 10 th May 2020, corresponding with the period of greatest community restrictions. The following data were extracted: place of injury, mechanism of injury, mode of hospital transport, level 1 vs level 2 trauma, intensive care unit (ICU) or high dependency unit (HDU) admission. For data fields with consistency across the two databases, 2020 data were compared with trauma presentations during the same date range (23 rd March to 10 th May) within the years 2014-2019, selecting 2014 to ensure consistency of Trauma Team Activation Criteria.

There was no change in patient numbers meeting trauma call criteria presenting to our hospital during the period of interest in 2020 (91 patients, nine level 1) compared with the corresponding time-frame in 2014-2019 (median 84 patients, range 64-100; Chi-squared analysis p=0.6 ). Similar to international data 2 , we saw an increased proportion of injuries occurring at home (42.8% in 2020, vs median 18.4%, range 14.1%-25% in 2014-2019, Chi-squared analysis p<0.002).

During the pandemic time period in 2020, three paediatric trauma patients required ICU admission, and one required HDU admission.Nine patients were retrieved by either the Royal Flying Doctor Service or South Australian Ambulance Service (SAAS) MedSTAR helicopter and 44 required road ambulance transportThis represents a strain on resources that must be considered during a pandemic where ICU beds and ambulance services may be at a premium. This article is protected by copyright. All rights reserved.

Differences in mechanism and place of injury during the pandemic can provide targets for injury prevention strategies. The study period coincided with the Easter school holidays. Families who would normally travel have stayed home this year and sought out activities closer to home.

Paediatric quad bike trauma has been an area of major concern for the Royal Australasian College of Surgeons 6 . We admitted a cluster of four quad bike trauma cases during our 7-week lockdown period, all injured on domestic properties. This compares with one recreational case each in the corresponding time periods of 2019 and 2018 and an annual median incidence of 7.5 per year 2014-2019. Motorbike injuries also occurred, involving 13 children and adolescents in during the lockdown in 2020. In contrast to NZ, where no child or adolescent motor vehicle occupants were significantly injured during their lockdown 2 , we treated 8 occupants from motor vehicle accidents. Trampolining and bicycle riding have increased around the world during the pandemic 1, 7 . The majority of these injuries do not meet our criteria for database inclusion and therefore we cannot comment on rates in our setting. However, previous research from our department identified that the majority of trampoline injuries are preventable with appropriate safety measures 8 . These activities could be targeted with appropriate educational messages in the media, schools and other locations.

In 2020, four major trauma presentations resulted from inflicted injuries (assault or non-accidental injury) compared with two cases in 2018 and none in 2019. There were two cases of self-harm in SA did not see a reduction in level 1 and 2 trauma presentations at the paediatric major trauma centre in 2020 during the COVID-19 pandemic during a legislated period of restriction in sporting activities, gatherings and travel when compared with the same time period 2014-2019. As this is in stark contrast to NZ data, health services must consider their own circumstances when resource planning for the current and future pandemics. It is possible that a stricter lockdown would lead to a decrease in trauma presentations, however the large number of significant injuries that occurred at home or in the local environment, including quad and motor bike injuries, suggests that education and public health initiatives may be vitally important to prevent serious injury and conserve medical resources during future pandemics.

Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand

Reduction of childhood trauma during the COVID-19 level 4 lockdown in

The corresponding author is not the recipient of a research scholarship.The authors thank Ms Georgia Antoniou for her assistance with statistical analysis.