Patterns and mechanisms of major trauma injuries during and after the UK Covid-19 Nationwide lockdown: analysis from a UK Major Trauma Centre
Authors: Adiamah Alfred , Lewis-Lloyd Christopher , Seehra Jaspreet K. , Rashid Adil , Dickson Edward , Moody Nick , Blackburn Lauren , Reilly John-Joe , Saunders John , Brooks Adam ,   ICON Trauma Study Group, Adiamah Alfred , Anis Fady , Anogo Ruth , Bennett James , Blackburn Lauren , Brooks Adam , Brailsford Rachel , Bua Atiba Akii , Dahaley Amanjeet , Dhital Ketan , Dickson Edward , Draper Zoe , Freij Ramzi , Gaskin Wendy , Gida Sunil , Hall Michael , Hossain Tanvir , Hutchinson Lauren , Jackman Jamaall , Kapeleris Audrey , Lamb Christopher , Lewis-Lloyd Christopher , La Valle Angelo , McSweeny Shane , Nassif Yasar , Navarro Alex , O’Sullivan Ciara , O’Connor Rory , Oyende Olamide , Rashid Adil , Rasquinha Melroy , Reilly John-Joe , Samuels Sabrina , Saunders John , Seehra Jaspreet , Srikumar Bhairavi , Taylor Laura Sandland , Shaw Melissa , Tay Vei Lynn , Thompson Amari , Theophilidou Elena , Tumilty Sue , Varghese Benjamin , Winter Robert 
Published: May 2022

Abstract
Purpose
To compare patterns and mechanisms of injuries during and after the UK Nationwide lockdown during the COVID-19 pandemic.

Methods
This prospective cohort study included all major trauma admissions during the 10-week period of the nationwide lockdown (09/03/2020–18/05/2020), compared with admissions in the 10-weeks following the full lifting of lockdown restrictions (04/07/20–12/09/2020). Differences in the volume, spectrum and mechanism of injuries presenting during and post-lockdown were compared using Fisher’s exact and Chi-squared tests as appropriate. The associated risk of 30-day mortality was examined using univariable and multivariable logistic regression.

Results
A total of 692 major trauma admissions were included in this analysis. Of these, 237 patients were admitted during the lockdown and 455 patients were admitted post-lockdown. This represented a twofold increase in trauma admission between the two periods. Characteristically, both cohorts had a higher proportion of male patients (73.84% male during lockdown and 72.5% male post-lockdown). There was a noted shift in age groups between both cohorts with an overall more elderly population during lockdown (p = 0.0292), There was a significant difference in mechanisms of injury between the two cohorts. The 3-commonest mechanisms during the lockdown period were: Road traffic accidents (RTA)—31.22%, Falls of less than 2 m—26.58%, and falls greater than 2 m causing 22.78% of major trauma admissions. However, in the post-lockdown period RTAs represented 46.15% of all trauma admissions with falls greater than 2 m causing 17.80% and falls less than 2 m causing 15.16% of major trauma injuries. With falls in the elderly associated with an increased risk of mortality. In terms of absolute numbers, there was a twofold increase in major trauma injuries due to stabbings and shootings, rising from 25 admitted patients during the lockdown to 53 admitted patients post-lockdown.

Conclusions
The lifting of lockdown restrictions resulted in a twofold increase in major trauma admissions that was also associated with significant changes in both the demographic and patterns of injuries with RTA’s contributing almost half of all injury presentations.
Trial registration: This study was classed as a service evaluation and registered with the local audit department, registration number: 20-177C.