In our study, we found out that there was a 34% decrease in trauma cases admitted to the Department of Emergency in the March-June 2020 period compared to the previous year. Besides, no significant difference was determined between the mentioned periods regarding trauma mechanisms. However, we found a higher post-traumatic death rate during the pandemic.
The decrease in trauma cases during the pandemic period may be due to the decrease in traumatic injuries because of the social restrictions and lockdown mandates, or because patients after minor trauma did not apply to hospitals for fear of COVID-19 contamination. Similar to our study, Harnett et al. compared March 29-April 25, 2020 with March 31-April 27, 2019, and found that there was a 42% decrease in the Department of Emergency admissions (11). İlhan et al., in their single-center study, revealed a 60% decrease in trauma admissions during the pandemic (12). In another study comparing before and after lockdown, it was shown that post-traumatic hospitalization decreased by 30.9% during the lockdown period (13). In another study conducted with 618 patients, it was stated that the need for open surgery increased in the pandemic period compared to the pre-pandemic period, although a 25% decrease was detected in the patients who applied to the emergency department for surgical reasons during the pandemic period (10). In the study investigating the injury-related hospitalization of 21 hospitals between March 15-April 30, 2016-2020, it was shown that hospitalization decreased by 26% during the lockdown period (14).
Regarding the trauma mechanisms, Chiba et al. found a 38.7% reduction in motorcycle accidents, a 42.5% reduction in auto versus pedestrian accidents, a 28.4% reduction in bicycle accidents. However, they did not report a significant reduction in motor vehicle accidents during pandemic (15). Besides, DiFazio et al. reported a 75% reduction in motor vehicle accidents and a 28.9% reduction in falls, along with a 44.9% reduction in trauma admissions during the lockdown period of the pandemic (16). Moreover, İlhan et al. detected a significant decrease in pedestrian injuries during the pandemic (12). On the other hand, in our study, unlike these studies, the trauma mechanism was similar in the specified periods of all three years. Albeit a significant decrease in traumatic injuries was an expected finding during the pandemic, it was remarkable for us that the trauma mechanism did not change. The reason for this may be that although there are social restrictions and lockdowns, a substantial group, such as people with special work permits or motor couriers, is exempt from these bans. In addition, although the decrease in the number of vehicles on the road relieves Istanbul traffic, the trauma mechanism may not change compared to previous years due to the use of vehicles at higher speeds on relatively empty roads. When we examined the traumatic injuries in our study, the fact that intracranial bleeding, hemothorax, lung contusion, intestinal perforation, urinary system injury, free fluid in the abdomen, soft tissue injury, rib fracture, and femur fracture were detected more frequently in the March-June 2020 period compared to previous parallel years support the exposure to high-energy trauma during the pandemic period. Hence, we consider that the enforcement of traffic rules and raising public awareness about traumas are of considerable importance even during lockdown periods.
Chiba et al. revealed that mortality decreased during the lockdown period compared to the previous year (15). On the other hand, Yasin et al. showed that mortality was higher during the pandemic period in their study, in which they included 750 road traffic collision patients during the pre-COVID-19 period and 499 road traffic collision patients during the COVID-19 period (17). Likewise, when we looked at the post-traumatic death rates in our study, there was a significant increase in the death rate in 2020. The reason for this may be the occurrence and mortality of high-energy traumatic injuries at higher speeds in reduced traffic. Furthermore, a more elective approach to the patients due to the pandemic and the waiting for the PCR results for the operation during the pandemic might increase the mortality. The current study has some limitations. Firstly, it was a retrospective study and therefore some data were not available. Trauma scores could not be calculated due to missing data. Although we showed that some injuries were more common in the Covid-19 period in our study, we could not compare the trauma scores with the pre- and post-Covid-19 periods. Secondly, although we conducted a multicenter study, regional studies with larger participation are needed to analyze the effects of the Covid-19 pandemic and social isolation on trauma.