There were 750 hospitalized RTC trauma patients in the year before the COVID-19 Pandemic and 499 hospitalized RTC trauma patients during the first year of the Pandemic. This gives an annual incidence of RTC hospitalization of 97.9 /100 000 population in the year before the COVID-19 Pandemic and 65.1/100 000 population during the first year of the Pandemic. There was a 33.5% reduction in the annual RTC hospitalization in Al-Ain City. Figure 1 shows that the maximum drop was in the first five months (April-August 2020) when there was a lockdown with severe restriction of outdoor movements.
Table 1 shows the demography of the two periods. UAE nationals were significantly less during the COVID-19 Pandemic (p = 0.004, Fisher’s Exact test). The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher’s Exact test). Motor vehicle collisions were less frequent during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3 % compared with 11.2 %).
Table 1
Demography of hospitalized patients involved with road traffic collisions during the periods of March 2019-February 2020 (n = 750) and March 2020-February 2021(n = 499), Al-Ain City, United Arab Emirates.
Variable | Pre-COVID Period n = 750 | COVID Period n = 499 | P value |
Age | 29.8 (16.1) | 29.31 (14.9) | 0.94 |
Male | 616 (82.1) | 413 (82.8) | 0.82 |
Nationality | | | 0.004 |
United Arab Emirates | 373 (51) | 205 (42.4) | |
Non-UAE | 359 (49) | 278 (57.6) | |
Mechanism of injury | | | < 0.0001 |
Motor vehicle collision | 540 (72) | 302 (60.5) | |
Motorcycle | 84 (11.2) | 116 (23.3) | |
Bicycle | 42 (5.6) | 35 (7) | |
Pedestrian | 84 (11.2) | 46 (9.2) | |
Mode of arrival | | | 0.29 |
Ground ambulance | 610 (81.7) | 421 (84.4) | |
Private car/walking-in | 120 (16.1) | 72 (14.4) | |
Helicopter ambulance | 17 (2.2) | 6 (1.2) | |
Data are presented as mean (SD) for continuous data and number (%) for categorical data. |
RTC patients who were admitted during the Pandemic had significantly lower systolic blood pressure and significantly higher respiratory rate on arrival to the hospital compared with those admitted in the pre-COVID period (mean (SD) 127 (19.2) mmHg compared with 132.2 (23.7) mmHg, p < 0.0001, Mann Whitney-U test) and (mean (SD) 20.2 (3) compared with 19.7 (4.4), p < 0.0001, Mann Whitney-U test) respectively. The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4 % compared with 2.3 %, p = 0.045, Fisher’s Exact test) (Table 2).
Table 2
Severity markers of hospitalized patients involved with road traffic collision during the periods of March 2019-February 2020 (n = 750) and March 2020 -February 2021 (n = 499), Al Ain City, United Arab Emirates.
Variable | Pre-COVID Period n = 750 | COVID Period n = 499 | P value |
Systolic blood pressure (mmHg) | 132.2 (23.7) | 127 (19.2) | < 0.0001 |
Respiratory rate/minute | 19.7 (4.4) | 20.16 (3) | < 0.0001 |
Pulse (beat per minute) | 93.3 (21.4) | 95.01 (20.6) | 0.16 |
GCS | 15 (3–15) | 15 (3–15) | 0.63 |
ISS | 5 (1–75) | 5 (1–38) | 0.14 |
ICU admission | 103 (13.7) | 66 (13.2) | 0.87 |
ICU stay (days) | 1.31 (4.92) | 1.05 (4.17) | 0.69 |
Hospital stay (day) | 6.59 (11.9) | 5.01 (7.6) | 0.90 |
Dead | 17 (2.3) | 22 (4.4) | 0.045 |
GCS = Glasgow Coma Scale, ISS = Injury Severity Score, ICU = Intensive Care Unit |
Data are presented as mean (SD) for continuous data, median (range) for ordinal data and number (%) for categorical data. |
Tables 3 and 4 show the univariate analysis comparing those who died and those who survived in our study. The mechanism of injury was significantly different between those who died and those who survived (p = 0.03, Fisher’s Exact test). Pedestrian injuries were more frequent in those who died (23.1% compared with 10 %), while bicycle injuries were less frequent in them (0% compared with 6.4%). There was a strong trend for patients who died to arrive by ground and helicopter ambulances (p = 0.06, Fisher’s Exact test) (Table 3).
Table 3
Demography of hospitalized patients involved with road traffic collision during the periods of March 2019-February 2021 in those who survived (n = 1210) and those who died (n = 39), Al-Ain City, United Arab Emirates.
Variable | Alive n = 1210 | Dead n = 39 | P value |
Age | 29.7 (5.7) | 27.6 (14.7) | 0.56 |
Male | 996 (82.3) | 33 (84.6) | 0.83 |
Nationality | | | 0.87 |
United Arab Emirates | 562 (47.6) | 16 (45.7) | |
Non-UAE | 618 (52.4) | 19 (54.3) | |
Mechanism of injury | | | 0.03 |
Motor vehicle collision | 816 (67.4) | 26 (66.7) | |
Motorcycle | 196 (16.2) | 4 (10.3) | |
Bicycle | 77 (6.4) | 0 (0) | |
Pedestrian | 121 (10) | 9 (23.1) | |
Mode of arrival | | | 0.06 |
Ground ambulance | 996 (82.5) | 35 (89.7) | |
Private car/walking-in | 190 (15.7) | 2 (5.1) | |
Helicopter ambulance | 21 (1.7) | 2 (5.1) | |
Period | | | 0.045 |
Pre-COVID | 733 (60.6) | 17 (43.6) | |
COVID | 477 (39.4) | 22 (56.4) | |
Data are presented as mean (SD) for continuous data and number (%) for categorical data. |
Table 4
Severity markers of hospitalized patients involved with road traffic collision during the periods of March 2019-February 2021 in those who survived (n = 1210) and those who died (n = 39), Al-Ain City, United Arab Emirates.
Variable | Alive n = 1210 | Dead N = 39 | P value |
Systolic blood pressure (mmHg) | 130.9 (20.1) | 85.26 (63.5) | 0.003 |
Respiratory rate/minute | 20 (3.6) | 14.1 (12.6) | 0.02 |
Pulse (beat per minute) | 94.28 (19.1) | 78.17 (65.8) | 0.99 |
GCS | 15 (3–15) | 3 (3–14) | < 0.0001 |
ISS | 5 (1–45) | 25 (9–75) | < 0.0001 |
ICU admission | 159 (13.1) | 10 (25.6) | 0.03 |
ICU stay (days) | 1.16 (4.6) | 2.54 (5.4) | 0.02 |
GCS = Glasgow Coma Scale, ISS = Injury Severity Score, ICU = Intensive Care Unit |
Data are presented as mean (SD) for continuous data, median (range) for ordinal data and number (%) for categorical data. |
Those who died had significantly lower systolic blood pressure on arrival to the hospital compared with those who survived (mean (SD) 85.3 (63.5) mmHg compared with 130.9 (20.1) mmHg, (p = 0.003, Mann Whitney-U test); significantly lower respiratory rate on arrival to the hospital compared with those who survived (mean (SD) 14.1 (12.6) compared with 20 (3.6), p = 0.02, Mann Whitney-U test); significantly lower GCS compared with those who survived ((median (range) 3 (3–14) compared with 15 (3–5), p < 0.0001, Mann Whitney-U test), significantly higher ISS compared with those who survived (median (range) 25 (9–75) compared with 5 (1–45), p < 0.0001, Mann Whitney-U test). They were significantly more likely to be admitted to the ICU compared with those who survived (25.6 % compared with 13.1%, p = 0.03, Fisher’s Exact test), and stayed significantly longer in the ICU (mean (SD) 2.54 (5.4) days compared with 1.16 (4.6) days, p = 0.02, Mann Whitney-U test). RTC hospitalized patients died significantly more during the Pandemic compared with the pre-COVID period (56.4% compared with 43.6%, p = 0.045, Fisher’s Exact test). (Table 4).
Table 5 shows the outcome of the logistic regression model that predicts mortality in our studied patients. The model was highly significant with a high R squared (p < 0.0001, Nagelkerke R2 = 0.83). The R square indicates that more than 80% of the variation of the data can be explained by the selected factors. The significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality.
Table 5
Backward logistic regression model defining significant factors affecting mortality.
| Coefficient | S.E. | Wald | P value | OR | OR 95% CI Lower Upper |
GCS | -0.82 | 0.14 | 35.54 | < 0.0001 | 0.44 | 0.34 | 0.58 |
ICU admission | -4.46 | 1.22 | 13.36 | < 0.0001 | 0.01 | 0 | 0.13 |
ISS | 0.08 | 0.04 | 4.00 | 0.045 | 1.08 | 1 | 1.16 |
Pandemic period | 1.48 | 0.78 | 3.60 | 0.058 | 4.37 | 0.95 | 20.05 |
Constant | 3.94 | 1.65 | 5.74 | 0.017 | 51.42 | | |
SE = Standard error, OR = Odds Ratio, CI = Confidence Interval |