Effect of the Covid-19 Lockdown Regulations on the Severe Trauma Burden in an Urban Trauma Centre in Johannesburg, South Africa

Abstract

Background During the Covid-19 pandemic, the South African government introduced stringent lockdown restrictions. Social restrictions affected patient presentation to hospitals with non-Covid related illnesses. Objectives The aim of this research was to investigate the effect of lockdown on major trauma presentation in a level one trauma centre in Johannesburg, as well as to assess how lockdown affected emergency and semi-emergency trauma surgical procedures. Method This is a retrospective data analysis of major trauma patients presenting to Charlotte Maxeke Johannesburg Academic Hospital between 26 March and 13 July in 2020 and 2019. The Medibank records of priority one patients presenting to the hospital over these time periods were reviewed, and data were analysed per level of lockdown- patient demographics, day of the week on presentation, mechanism of injury and patient discharge destination from casualty were recorded. Index Severity Scores (ISS) were calculated based on presenting injuries, imaging and intra-operative findings. All emergency and semi-emergency procedures over this time were also analysed. The 2019 and 2020 data were compared, and statistical differences were calculated. A p-value of <0.05 was considered statistically significant. Results An analysis of 1060 patients split between 595 patients in 2019 and 465 in 2020 was made. Level 5 lockdown in 2020 had statistically significantly fewer priority one trauma case than 2019 (p=0.000), Level 4 had no statistically relevant change in patient number presenting to hospital, and Level 3 had statistically significant more priority one patients presenting in viii 2020 compared to 2019 (p=0.000). Penetrating trauma was the most common mechanism of injury in both years, with a statistically significant reduction in train- related injuries in 2020 (p=0.011) and slightly more ‘fall from heights’ in 2020 (p=0.033). Fewer weekend and public holiday major trauma presentations occurred during lockdown in 2020 (p= 0.003 and p=0.001 respectively) compared to 2019. Less emergency/ semi- emergency trauma surgeries were performed in 2020 in contrast to 2019 (p=0.000). Conclusion The results show a decline in major trauma presentation during the most limiting lockdown restrictions (Level 5) with a rebound increase in trauma during more relaxed lockdown regulations (Level 3). Lockdown shifted the presentation of major trauma to predominantly weekdays. There was a decline in surgical emergency and semi-emergency procedures but no change in overall ISS. The data highlights the diversity and complexity of trauma in Johannesburg, with difficulty in identifying primary prevention strategies.