1
|
Loza-Avalos SE, DeAtkine E, Ochoa M, Treviño R, Diercks K, Edwards C, George J, Lunardi N, Paquette S, Bisgaard E, Kuhlenschmidt K, Cripps M, Park C. Burn and Trauma Burden and Screening for Interpersonal Violence During the COVID-19 Pandemic. J Surg Res 2024; 298:386-392. [PMID: 37957086 DOI: 10.1016/j.jss.2023.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Nationwide shelter-in-place (SIP) orders during the pandemic have had long-lasting effects, including increased rates of domestic violence and interpersonal violence. Screening for violence varies by institution, which tool is used, and when. Given increases in burn and trauma admissions over the course of the pandemic, we sought to examine trends at our institution during this time period to better guide care and anticipate system-level effects. METHODS We performed a retrospective cohort study of pediatric burn and adult burn and trauma patients at our level 1 trauma/burn center between March-May 2019 and March-May 2020. Home safety screening was performed by nursing staff using a 1-part screening questionnaire. Patients presenting before March 15, 2020, were defined as "pre-SIP; " between March 16-May 19, 2020, were "during SIP; " and those after May 19, 2020, were designated as "post-SIP." Descriptive and chi-square statistics were used. Demographic, injury patterns, and screening information were collected. RESULTS Blunt trauma comprised 60% of injuries, followed by burns (30%) then penetrating injury (7%). Over the entire time period analyzed, 1822 patients had documented home safety screening; ∼2% of patients screened reported a safety concern pre-SIP, compared to 3% of patients during SIP. There were higher rates of burns and penetrating injury during SIP compared to other periods (P ≤ 0.0001). Home safety screening rates were 94%-95% pre- and during SIP, but dropped to 85% post-SIP (P < 0.0001). Home safety concerns were reported almost 2% of the time pre-SIP and 3% during SIP (P = 0.016). CONCLUSIONS We noted an increase in trauma and burns during and after SIP orders, consistent with the experiences of other institutions. Implementation of a nurse-driven screening process demonstrated high compliance with appropriate referrals. The burden of burn and traumatic injury remains significant, highlighting a need for continued psychosocial screening and the provision of psychosocial support resources in the acute trauma setting.
Collapse
Affiliation(s)
- Sandra E Loza-Avalos
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth DeAtkine
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manuela Ochoa
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Treviño
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kiersten Diercks
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Jessica George
- Department of Trauma, Parkland Memorial Hospital, Dallas, Texas
| | - Nicole Lunardi
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shannon Paquette
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erika Bisgaard
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kali Kuhlenschmidt
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Cripps
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Caroline Park
- Division of Burns, Department of Surgery, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
2
|
Sulaiman A, Lim CY, Brussius Coelho M, Hayward P, Nicklin S, Gianoutsos M. Effects of COVID-19 lockdown on emergency paediatric plastic surgery admissions. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n2.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: On 23rd March 2020, Australia went into a nationwide lockdown that led to school closures. As a result, children spent more time at home, increasing their vulnerability to injuries sustained at home. This study aims to analyse the patterns of emergency paediatric plastic surgery admissions into a tertiary paediatric hospital in Sydney during the COVID-19 lockdown period, and to raise awareness on the impacts of lockdown measures on the vulnerable pediatric population.
Methods: A retrospective analysis was conducted at a tertiary paediatric hospital in Sydney. Admissions into the Plastic and Reconstructive Surgery department during the lockdown period of 23rd March to 15th May 2020, and the same period in 2019 were included in the analysis. Ethics approval for the study was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee [HREC Reference 2021/ETH00451]
Results: There were 37 and 91 admissions in 2020 and 2019 respectively. The proportion of injuries sustained at home increased by 24% in 2020, consistent with increased time spent at home. The percentage of injuries due to animal bites and sharp objects increased while number of sports-related injuries and falls decreased during the lockdown. Motor vehicle accidents increased in 2020. More patients also opted for conservative management in 2020.
Conclusion: This study has shown that during a pandemic lockdown, home injuries are more common, children are less likely to present to hospital and more likely to opt for conservative management. With a greater understanding of patterns of paediatric injuries during lockdowns, the relevant authorities can develop targeted advisories for dissemination to the public on how to create a safe home environment for children.
Collapse
|
3
|
Georgeades CM, Collings AT, Farazi M, Fallat ME, Minneci PC, Sato TT, Speck KE, Van Arendonk K, Deans KJ, Falcone RA, Foley DS, Fraser J, Gadepalli S, Keller MS, Kotagal M, Landman MP, Leys CM, Markel TA, Rubalcava N, St. Peter SD, Flynn-O’Brien KT. A Multi-institutional Study Evaluating Pediatric Burn Injuries During the COVID-19 Pandemic. J Burn Care Res 2022; 44:399-407. [PMID: 35985296 PMCID: PMC9452075 DOI: 10.1093/jbcr/irac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 11/13/2022]
Abstract
During the COVID-19 pandemic, children were out of school due to Stay-at-Home Orders. The objective of this study was to investigate how the COVID-19 pandemic may have impacted the incidence of burn injuries in children. Eight Level I Pediatric Trauma Centers participated in a retrospective study evaluating children <18 years old with traumatic injuries defined by the National Trauma Data Bank. Patients with burn injuries were identified by ICD-10 codes. Historical controls from March to September 2019 ("Control" cohort) were compared to patients injured after the start of the COVID-19 pandemic from March to September 2020 ("COVID" cohort). A total of 12,549 pediatric trauma patients were included, of which 916 patients had burn injuries. Burn injuries increased after the start of the pandemic (COVID 522/6711 [7.8%] vs Control 394/5838 [6.7%], P = .03). There were no significant differences in age, race, insurance status, burn severity, injury severity score, intent or location of injury, and occurrence on a weekday or weekend between cohorts. There was an increase in flame burns (COVID 140/522 [26.8%] vs Control 75/394 [19.0%], P = .01) and a decrease in contact burns (COVID 118/522 [22.6%] vs Control 112/394 [28.4%], P = .05). More patients were transferred from an outside institution (COVID 315/522 patients [60.3%] vs Control 208/394 patients [52.8%], P = .02), and intensive care unit length of stay increased (COVID median 3.5 days [interquartile range 2.0-11.0] vs Control median 3.0 days [interquartile range 1.0-4.0], P = .05). Pediatric burn injuries increased after the start of the COVID-19 pandemic despite Stay-at-Home Orders intended to optimize health and increase public safety.
Collapse
Affiliation(s)
- Christina M Georgeades
- Corresponding Author: Christina Georgeades, MD Department of Surgery Medical College of Wisconsin 8701 W. Watertown Plank Road Milwaukee, WI 53226 Phone Number: 727-385-2203
| | - Amelia T Collings
- Department of Surgery, Indiana University, Indianapolis, IN, United States of America
| | - Manzur Farazi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America,Division of Pediatric Surgery, Children’s Wisconsin, Milwaukee, WI, United States of America
| | - Mary E Fallat
- Norton Children’s Hospital, Louisville, KY, United States of America,Hiram C. Polk, Jr Department of Surgery, University of Louisville, KY, United States of America
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States of America,Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Thomas T Sato
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America,Division of Pediatric Surgery, Children’s Wisconsin, Milwaukee, WI, United States of America
| | - K Elizabeth Speck
- Division of Pediatric Surgery, Mott Children’s Hospital, Ann Arbor, MI, United States of America
| | - Kyle Van Arendonk
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America,Division of Pediatric Surgery, Children’s Wisconsin, Milwaukee, WI, United States of America
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States of America,Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, United States of America,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - David S Foley
- Norton Children’s Hospital, Louisville, KY, United States of America,Hiram C. Polk, Jr Department of Surgery, University of Louisville, KY, United States of America
| | - Jason Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Samir Gadepalli
- Division of Pediatric Surgery, Mott Children’s Hospital, Ann Arbor, MI, United States of America
| | - Martin S Keller
- Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, United States of America
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, United States of America,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Matthew P Landman
- Department of Surgery, Indiana University, Indianapolis, IN, United States of America
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States of America
| | - Troy A Markel
- Department of Surgery, Indiana University, Indianapolis, IN, United States of America
| | - Nathan Rubalcava
- Division of Pediatric Surgery, Mott Children’s Hospital, Ann Arbor, MI, United States of America
| | - Shawn D St. Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Katherine T Flynn-O’Brien
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America,Division of Pediatric Surgery, Children’s Wisconsin, Milwaukee, WI, United States of America
| |
Collapse
|
4
|
Gallaher J, Abid M, Kayange L, Purcell L, Charles A. The effect of COVID-19 on burn management and outcomes in a resource-limited setting. Burns 2022; 48:1584-1589. [PMID: 36038452 PMCID: PMC9375248 DOI: 10.1016/j.burns.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
Introduction Optimal burn care includes fluid resuscitation and early excision and grafting. During the COVID-19 pandemic, resource-constrained environments were susceptible to interruptions in burn care. We sought to characterize pre- and intra-pandemic burn-associated outcomes at a busy tertiary hospital in Malawi. Methods This is a retrospective analysis of burn patients that presented to Kamuzu Central Hospital Lilongwe from 2011 through December 2021. We compared patients based on whether they presented pre- or intra-pandemic, starting on March 11, 2020, the date of official WHO designation. Comparing these cohorts, we used modified Poisson modeling to estimate the adjusted risk of undergoing an operation and the risk of death. Results We included 2969 patients, with 390 presenting during the pandemic. Patient factors were similar between the cohorts. More patients underwent surgery pre-pandemic (21.1 vs 10.3 %, p < 0.001) but crude mortality was similar at 17.3 % vs. 21.2 % (p = 0.08). The RR of undergoing surgery during the pandemic was 0.45 (95 % CI 0.32, 0.64) adjusted for age, sex, % TBSA, flame burns, and time to presentation. During the pandemic, the risk ratio for in-hospital mortality was 1.23 (95 % CI 1.01, 1.50) adjusted for age, sex, % TBSA, surgical intervention, flame burns, and time to presentation. Conclusions During the pandemic, the probability of undergoing burn excision or grafting was significantly lower for patients, independent of the severity. Consequently, the adjusted risk of mortality was higher. To improve patient outcomes, efforts to preserve operative capacity for burn patients during periods of severe resource constraint are imperative.
Collapse
Affiliation(s)
- Jared Gallaher
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mustafa Abid
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Laura Purcell
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| |
Collapse
|
5
|
Dabek RJ, Vlasov A, Savenko M, Pasunko A, Driscoll DN, Knittel JG, Fuzaylov G. Resumption of Short-term Burn Reconstruction Missions to Ukraine in Light of COVID-19: A Paradigm Shift. J Burn Care Res 2022; 43:1410-1415. [PMID: 35441694 PMCID: PMC9047201 DOI: 10.1093/jbcr/irac049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has disrupted the lives of billions of people globally. Some medical systems continue to be overburdened due to the viral illness leading to incredible public health challenges domestically as well as abroad. However, with vaccination distribution increasing globally, many are pushing for a return to some form of normalcy. In the medical community, some are weighing the risks of returning to global health missions and considering protective strategies to minimize risk of viral spread. Here we describe our experience in returning to an annual burn reconstruction mission in a low- and middle-income country. We have successfully carried out a return surgical mission trip. Our team of ten individuals was able to perform over 75 procedures on 25 pediatric patients in four operative days. We applied a variety of protective strategies and altered mission protocol to limit exposure and transmission risk while focusing heavily on education and training Additionally, we increased the use of telemedicine and eliminated typical in person clinic visits. We increased operative complexity to increase impact while limiting patient exposure. Rigorous perioperative safety and follow-up protocols were implemented. The increased use of telemedicine, reduction of in person visits, emphasis on education, and implementation of safety and follow-up protocols have led to an improvement in efficiency, safety, and accountability. Our adaptations have provided guidance on responsibly resuming surgical outreach missions, with changes that are likely to endure beyond the COVID-19 pandemic.
Collapse
Affiliation(s)
- Robert J Dabek
- Department of General Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Alexey Vlasov
- Chief of Staff, Regional Children's Hospital, Dnipro, Ukraine
| | - Maxim Savenko
- Department of Pediatric Surgery, Dnipro State Medical School, Dnipro, Ukraine
| | - Artem Pasunko
- Department of General Surgery, Regional Children's Hospital, Dnipro, Ukraine
| | - Daniel N Driscoll
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin G Knittel
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Gennadiy Fuzaylov
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Rogers AD, Cartotto R. The Impact of COVID-19 on Burn Care at a Major Regional Burn Center. J Burn Care Res 2021; 42:110-111. [PMID: 33057612 PMCID: PMC7665536 DOI: 10.1093/jbcr/iraa181] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alan D Rogers
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Cartotto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Smith ACD, Miranda BH, Strong B, Jica RCI, Pinto-Lopes R, Khan W, Martin NA, El-Muttardi N, Barnes D, Shelley OP. St Andrew's COVID-19 surgery safety (StACS) study: The Burns Centre experience. Burns 2021; 47:1547-1555. [PMID: 33549394 PMCID: PMC7847194 DOI: 10.1016/j.burns.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 12/24/2022]
Abstract
Background The COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has the potential to significantly impact burns patients both directly through infective complications of an immunocompromised cohort, and indirectly through disruption of care pathways and resource limitations. The pandemic presents new challenges that must be overcome to maintain patient safety; in particular, the potential increased risks of surgical intervention, anaesthesia and ventilation. This study comprehensively reviews the measures implemented to adapt referral pathways and mitigate the risk posed by COVID-19 during the height of the pandemic, within a large Burns Centre. Methods A prospective cohort study was designed to assess patients treated at the Burns Centre during the UK COVID-19 pandemic peak (April–May 2020), following implementation of new safety measures. All patients were analysed for 30-day mortality. In addition, a prospective controlled cohort study was undertaken on all inpatients and a random sample of outpatients with telephone follow-up at 30 days. These patients were divided into three groups (operative inpatients, non-operative inpatients, outpatients). COVID-19 related data collected included test results, contact with proven cases, isolation status and symptoms. The implemented departmental service COVID-19 safety adaptations are described. Results Of 323 patients treated at the Burns Centre during the study period, no 30-day COVID-19 related deaths occurred (0/323). Of the 80 patients analysed in the prospective controlled cohort section of the study, 51 underwent COVID-19 testing, 3.9% (2/51) were positive. Both cases were in the operative group, however in comparison to the non-operative and outpatient groups, there was no significant increase in COVID-19 incidence in operative patients. Conclusions We found no COVID-19 related mortality during the study period. With appropriate precautions, burns patients were not exposed to an increased COVID-19 risk. Similarly, burns patients undergoing operative management were not at a significantly increased risk of contracting COVID-19 in comparison to non-operative groups.
Collapse
Affiliation(s)
- A C D Smith
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK.
| | - B H Miranda
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - B Strong
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - R C I Jica
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - R Pinto-Lopes
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - W Khan
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - N A Martin
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Centre for Trauma Sciences, Queen Mary University of London, UK
| | - N El-Muttardi
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - D Barnes
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - O P Shelley
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| |
Collapse
|
8
|
Demircan M. Increased admissions and hospitalizations to pediatric burn center during COVID 19 pandemic. Burns 2020; 47:487-488. [PMID: 33272740 PMCID: PMC7382929 DOI: 10.1016/j.burns.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mehmet Demircan
- Department of Pediatric Surgery, İnönü University School of Medicine, Malatya, Turkey.
| |
Collapse
|