A review of the complications encountered in a quaternary trauma intensive care unit in South Africa

The trauma burden on a tertiary surgical intensive care unit during the lockdown period in South Africa: A retrospective observational study

Background

Trauma places a significant burden on scarce South African critical care resources. The impact of the lockdown period in 2020 on these resources has not been studied. Restrictions on citizen movement and alcohol sales during the lockdown period presented a unique time period to investigate the burden of trauma on a low–middle-income country tertiary hospital intensive care unit.

Methods

A retrospective observational analysis of all patients admitted to a tertiary hospital surgical intensive care unit during the lockdown period in 2020, compared to the same time period in 2019 and 2018. Data were analysed to detect if a significant difference was present in the number of trauma admissions, length of stay and mechanisms of trauma.

Results

A significant decrease in the number of trauma admissions to ICU in 2020 was observed as compared to 2018 and 2019 during the same period ( p = <0.001), with a reduction of nearly 50%. The incidence of trauma admissions was lower in all individual lockdown levels in 2020 as compared to 2018 and 2019, and the lowest incidence was recorded in level 5 of 2020. There was no difference among the length of stay of trauma patients in ICU in 2018, 2019 and 2020. There was no difference between the incidence of trauma admissions during lockdown level 3 (with and without alcohol sales) in 2020 compared to 2018. The profile of penetrating and non-penetrating trauma over the 3 years was the same ( p = 0.22). There were no interactions between years, lockdown periods and penetrating trauma ( p = 0.22).

Interpretation

There was a significant decrease in the trauma burden presented to the surgical ICU during the lockdown period in 2020. Levels with the strictest restrictions on movement and alcohol use had the greatest measurable impact. The decreased number of trauma patients admitted in 2020 was comparable to the national trend of decreased trauma numbers recorded in all levels of the national healthcare system.

Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017

PURPOSE

This study sought to investigate the screening accuracy of procalcitonin (PCT) for bacteremia, as defined by a positive blood culture, in a South African trauma ICU.

METHODS

This was a retrospective chart review study involving 149 patients who were admitted to the ICU of a level-1 trauma center in South Africa between 2016 and 2017. Median PCT levels in patients with and without positive blood cultures were compared. The screening accuracy of PCT for a positive blood culture was summarized as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Two PCT cut-points were investigated: a general cut-point in the South African context (> 2.0 ng/mL), and a trauma ICU-specific cut-point (prioritizing specificity while optimizing sensitivity) which was determined from a receiver-operator-characteristic curve.

RESULTS

Bacteremic patients had higher median PCT levels when compared with non-bacteremic patients (30.5 ng/mL versus 6.6 ng/mL, p = 0.002). The sensitivity, specificity, PPV, and NPV of PCT > 2.0 ng/mL was 86% (95% confidence interval-CI 71-94%), 29% (CI 22-38%), 28% (CI 20-37%), and 87% (CI 73-94%), respectively. The unit-specific cut-point was PCT > 31.0 ng/mL, which had a sensitivity, specificity, PPV, and NPV of 50% (CI 34-66%), 80% (CI 71-86%), 44% (CI 30-59%), and 83% (CI 75-89%), respectively. Unlike PCT > 2.0 ng/mL, PCT > 31.0 ng/mL demonstrated fair-to-good test specificity in a sub-analysis of patients who underwent recent surgery.

CONCLUSIONS

Increased PCT levels were associated with bacteremia in this study. PCT > 31.0 ng/mL may be used to rule in suspected bacteremia in this trauma ICU setting.