Nadelige effecten van de covid-19-pandemie op ernstig gewonde patiënten in Nederland

Objective

To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands.

Summary background data

Severely injured patients highly rely on immediate access to specialised services, including intensive care unit (ICUs), shortages caused by the impact of the COVID-19 pandemic may influence their outcome.

Methods

A comprehensive multi-center prospective observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019.

Results

During the COVID-19 peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% versus 55.8%; p=0.016). Patients with less severe brain injuries were in particular less often admitted to the ICU during the peak (40.5% vs 52 .5%; p=0.005). Moreover, this subgroup showed an increased mortality compared to the reference group (13.5% vs 7.7%; p=0.044). In addition, a significant increase in observed versus predicted mortality was also recorded for patients who had a priori predicted mortality of 50% to 75% (p=0.012).

Conclusions

We speculate that the restricted availability of ICU beds negatively influenced the outcome of major trauma patients during the COVID-19 peak in 2020. In particular for patients with less severe traumatic brain injuries or with a high mortality probability.

Conflict of interest and financial support: none declared.