Intensive care unit admissions with and without COVID-19 in Finland from 2017 to 2021: a retrospective register-based study.

BACKGROUND: After the COVID-19 pandemic started, critical care resources were expanded in Finland to manage a possible surge in patients requiring intensive care. The aim of this study was to evaluate the incidence of overall ICU admissions, patient diagnoses, characteristics, and length of stay during the pandemic. METHODS: This retrospective hospital register-based study was conducted in two large and one mid-size Finnish public hospitals. The required data were collected from ICU patient information systems and all adult patients were included. Monthly and yearly incidences with 95% confidence intervals (CI) were counted per 100 000 persons-years by Poisson exact method and compared by incidence rate ratios (IRR). RESULTS: A total of 4407 admissions to ICUs for any cause occurred during 2020. In 2021, this figure was 4931. During the reference years (2017-2019), the mean number of admissions to ICU was 4781. In 2020 and 2021, the proportion of patients requiring intensive care due to COVID-19 was only 3%. The incidence of all-cause ICU admissions decreased during the lockdown in 2020 when compared to the reference years. Before the start of the lockdown in February 2020, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18). During the lockdown period, however, the IRR of all-cause ICU admissions decreased to 0.78 (CI: 0.67 to 0.90) in March. When the lockdown ended, the incidence rebounded to the same level as before the lockdown. However, in 2021, the incidence of ICU admissions remained at the same level when compared to the reference years. The most prominent changes occurred in the incidence of diseases of the nervous system, which includes epilepsy and seizures and transient cerebral ischemic attacks, in diseases of the respiratory system, and neoplasms. CONCLUSIONS: According to the findings of this study, the incidence of all-cause ICU admissions decreased after the lockdown was implemented in 2020. Furthermore, the percentage of patients requiring intensive care due to COVID-19 in Finland was only 3% in 2020 and 2021. These findings may serve to help in the planning and allocating of ICU resources during future pandemics.

Trends in Emergency Department Visits and Surgeries due to Traumatic Brain Injury During the COVID-19 Pandemic in Finland.

We aim to evaluate the changes in the incidence of TBI, trauma craniotomies, and craniectomies during the COVID-19 pandemic in Finland. This retrospective register study was conducted at three Finnish hospitals. We retrieved the numbers of emergency department (ED) visits, inpatient admissions, and trauma craniotomies and craniectomies due to TBI in the adult population from 2017 to 2020.We calculated the incidences per 100 000 inhabitants and compared the year 2020 to the reference years (2017-2019) by incidence rate ratios (IRR) with 95% confidence intervals. The incidence of TBI-related ED visits during the study period compared to the reference years started to decrease in March 2020 (IRR 0.86, CI: 0.73-1.02), and the lowest incidence was seen in April 2020 (IRR 0.83, CI: 0.68-1.01). The incidence of ED visits showed a second decrease in December (IRR 0.80, CI: 0.67-0.96). The incidence of concussion decreased during the national lockdown in March (IRR 0.80, CI 0.66-0.97). The incidence of ED visits due to TBI decreased after the declaration of national lockdown in spring 2020 and showed a second decrease during regional restrictions in December. In addition, the incidence of neurosurgically treated TBI decreased during restaurant restrictions in the spring.

Trends in emergency department visits due to back pain and spine surgeries during the COVID-19 pandemic in Finland.

ABSTRACT: We aim to report the incidences of ED visits due to back pain, hospitalizations, and urgent spine surgeries during the first and second waves of COVID-19 in Finland. The number of emergency department visits and hospitalizations due to back pain as well as urgent spine surgeries in the adult population was collected from hospital discharge registers for the years 2017 through 2019 (reference years) and 2020.This study was conducted at three large Finnish hospitals. The monthly incidence with 95% confidence intervals (CI) of emergency department visits and hospitalizations due to back pain and spine surgeries in the three participating hospitals were calculated and compared by incidence rate ratios (IRR).Visits to ED due to back pain decreased during the pandemic. The incidence of ED visits due to back pain was similar in February (IRR 0.95, CI: 0.82-1.10), but a decrease was seen after lockdown began (March IRR 0.67, CI: 0.57-0.78; April IRR 0.65, CI: 0.56-0.76) compared to the reference years. A second decrease in visits was seen after regional restrictions were implemented in October (IRR 0.88, CI: 0.76-1.02). The most common diagnoses were non-specific back pain, lumbar disk herniation, and back contusion. Incidence of non-specific back pain decreased during the lockdown (March IRR 0.65, CI: 0.55-0.78) and regional restrictions (October IRR 0.83, CI: 0.70-0.98), whereas the rates of other diagnoses remained unchanged, and incidences of hospitalizations and urgent spine surgeries remained stable.A clear decrease in ED visits due to back pain was seen during the first and second waves of the pandemic. This decrease was mainly the result of patients with non-specific back pain avoiding visits to the ED. The incidence of specific back pain, hospitalizations, and urgent spine surgeries remained unchanged during the pandemic.

Alcohol use in severely injured trauma patients.

Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18-64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0-17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.