ABSTRACT
BACKGROUND: A community lockdown has a profound impact on its citizens. Our objective was to identify changes in trauma patient demographics, volume, and pattern of injury following the COVID-19 lockdown. METHODS: A retrospective review was conducted at a Level-1 Trauma Center from 2017 to 2020. RESULTS: A downward trend in volume is seen December-April in 2020 (R2 = 0.9907). February through April showed an upward trend in 2018 and 2019 (R2= 0.80 and R2 = 0.90 respectively), but a downward trend in 2020 (R2 = 0.97). In April 2020, there was 41.6% decrease in total volume, a 47.4% decrease in blunt injury and no decrease in penetrating injury. In contrast to previous months, in April the majority of injuries occurred in home zip codes. CONCLUSIONS: A community lockdown decreased the number of blunt trauma, however despite social distancing, did not decrease penetrating injury. Injuries were more likely to occur in home zip codes.
Subject(s)
COVID-19/prevention & control , Hospitals, Urban/trends , Physical Distancing , Trauma Centers/trends , Violence/trends , Adolescent , Adult , COVID-19/epidemiology , Female , Hospitals, Urban/standards , Hospitals, Urban/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Trauma Centers/standards , Trauma Centers/statistics & numerical data , Violence/statistics & numerical data , Wounds, Nonpenetrating/epidemiology , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/epidemiology , Wounds, Penetrating/therapy , Young AdultABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit (ICU) area, the operating room intensive care unit (ORICU). METHODS: Twenty-three ORs were converted into an 82-bed ORICU. Adaptations to the OR environment permitted the delivery of standard critical care therapies. Nonintensive-care-trained staff were educated on the basics of critical care and deployed in a hybrid staffing model. Anesthesia machines were repurposed as critical care ventilators, with accommodations to ensure reliable function and patient safety. To compare ORICU survivorship to outcomes in more traditional environments, we performed Kaplan-Meier survival analysis of all patients cared for in the ORICU, censoring data at the time of ORICU closure. We hypothesized that age, sex, and obesity may have influenced the risk of death. Thus, we estimated hazard ratios (HR) for death using Cox proportional hazard regression models with age, sex, and body mass index (BMI) as covariables and, separately, using older age (65 years and older) adjusted for sex and BMI. RESULTS: The ORICU cared for 133 patients from March 24 to May 14, 2020. Patients were transferred to the ORICU from other ICUs, inpatient wards, the emergency department, and other institutions. Patients remained in the ORICU until either transfer to another unit or death. As the hospital patient load decreased, patients were transferred out of the ORICU. This process was completed on May 14, 2020. At time of data censoring, 55 (41.4%) of patients had died. The estimated probability of survival 30 days after admission was 0.61 (95% confidence interval [CI], 0.52-0.69). Age was significantly associated with increased risk of mortality (HR = 1.05, 95% CI, 1.03-1.08, P < .001 for a 1-year increase in age). Patients who were ≥65 years were an estimated 3.17 times more likely to die than younger patients (95% CI, 1.78-5.63; P < .001) when adjusting for sex and BMI. CONCLUSIONS: A large number of critically ill COVID-19 patients were cared for in the ORICU, which substantially increased ICU capacity at NYP-Columbia. The estimated ORICU survival rate at 30 days was comparable to other reported rates, suggesting this was an effective approach to manage the influx of critically ill COVID-19 patients during a time of crisis.
Subject(s)
COVID-19/mortality , COVID-19/therapy , Hospital Mortality , Hospitals, Urban/organization & administration , Intensive Care Units/organization & administration , Operating Rooms/organization & administration , Aged , COVID-19/diagnosis , Critical Illness/therapy , Female , Hospital Mortality/trends , Hospitals, Urban/trends , Humans , Intensive Care Units/trends , Male , Middle Aged , New York City/epidemiology , Operating Rooms/trends , Organization and Administration , Survival Rate/trends , Treatment OutcomeSubject(s)
COVID-19/epidemiology , Hospitals, Urban/organization & administration , Pandemics , Trauma Centers/organization & administration , Clinical Protocols , Forecasting , Hospitals, Urban/trends , Humans , Medical Staff, Hospital/education , Patient Care Team/organization & administration , SARS-CoV-2 , Trauma Centers/trends , Traumatology/education , Videoconferencing , Wounds and Injuries/surgeryABSTRACT
We conducted a descriptive time-series study of pediatric emergency healthcare use during the onset of severe acute respiratory syndrome coronavirus 2 pandemic after a state-wide stay-at-home order. Our study demonstrated decreased volume, increased acuity, and generally consistent chief complaints compared with the prior 3 years (2017 through 2019). Ingestions became a significantly more common chief complaint in 2020.