Abstract
In the past 3 years, the COVID-19 pandemic has influenced every corner of the world and every aspect of patient treatment and management. The care of trauma patients was undoubtedly affected as it was one of the most frequently encountered and important conditions. Globally, researchers have examined the impact of COVID-19 on trauma patient care, trauma networks, and how the system evolved after the pandemic. Even during the crisis, efforts have ceaselessly been put in to discover new evidence, techniques, and devices for better trauma patient management. Researchers and studies of the current issue have also highlighted and addressed a few crucial areas.
Sephton et al. 1 conducted a study focused on the mechanism and diagnoses of injuries in a major trauma network in the United Kingdom during the lockdown in early 2020. They found a dramatic reduction in all emergency orthopedic referrals and the total number of operations performed. A similar phenomenon was observed in a city in China by Yang and Lu 2 ; there was a reduction in the volume of trauma patients throughout the trauma system. Wickramarachchi et al. 3 reported a setting with a dual site for delivering COVID-19-free trauma service and retaining the COVID-19 trauma service separately. The mode produced a significant gain in medical bed capacity, with 100% of the trauma patients under the care and emergency operations not having developed COVID-19. Hong Kong has also used a similar system in some clusters. COVID-19 and non–COVID-19-related cases, including trauma patients, were bundled to be managed in different hospitals. Experience gained during COVID-19 for managing trauma patients and networking during the pandemic is invaluable.
In the past years, there has been increasing awareness of the important role of metabolic derangements in trauma-related morbidities and mortality. Coagulopathy, hypothermia, and acidosis have been quoted as the “lethal triad” in trauma. Trauma-induced coagulopathy (TIC) is one of the most critical factors contributing to poor outcomes. TIC is present in approximately 24%–34% of hospitalized patients with trauma.4,5 Maegele 6 addressed that advances and modern coagulopathy management emphasize goal-oriented and individualized care, which are guided by point-of-care viscoelastic assays. Early identification followed by aggressive management is of utmost importance. 6 Evidence and recommendations are established to guide the use of various treatment options for TIC, which include tranexamic acid, fresh-frozen plasma, cryoprecipitate, and coagulation factor concentrates such as prothrombin complex concentrates and human fibrinogen concentrate. 7 Viscoelastic assay–based treatment algorithms, including thrombelastography and rotational thromboelastometry, are also gaining popularity. This leads to earlier identification of patients with coagulation abnormalities, resulting in more rapid and precise coagulation management.
Aging is a global problem nowadays. Geriatric trauma patient care has become a crucial area to study. Older people are at the greatest risk of poor outcomes and an increased risk of death after a serious injury. The anatomical and physiologic changes with aging impair their capacity to respond to the stress of injury. The medications geriatric patients take could mask the signs of significant injuries. Moreover, they are constantly being undertriaged, increasing their risk of morbidity and mortality. Braude et al. 8 evaluated the effect of geriatrician assessment on clinical outcomes for older people admitted to hospitals with serious injuries. The study showed that geriatrician assessment was associated with a reduced risk of death for seriously injured older people. It was also associated with a reduction in the duration of stay in critical care. How to integrate multidisciplinary care approaches need to be further examined, for a better care model and outcome for geriatric trauma patients.
Long-term outcomes for trauma patients may have been neglected. Advances in trauma patient care have improved the survival rate of injured patients. Further efforts are worth to be made for restoring the best possible health status for them. Research has been carried out on returning to work after an injury. 9 Hung et al. 9 found that lower education levels, physically demanding jobs, and work-related injuries have lower return-to-work rates. Long length of stay, not being discharged directly home, lower health-related quality of life, and worse functional outcome 1 month after an injury were also significant contributing factors. The researchers concluded that further studies required looking into methods to improve health status and return to work after injuries.
Authors of the current issue address several important areas of trauma patients, including traumatic brain injury (TBI) in children, 10 the impact of trauma centers on exsanguinating pelvic bone fractures, 11 the use of antibiotics in early-onset ventilator-associated pneumonia, 12 and topical medications for acute musculoskeletal injuries. 13 Outcomes and management of patients suffering from TBI have raised concerns and have been researched for some time. Studies have looked into biomarkers for the management of TBI patients including severity, the need for scanning, prognosis, and so on. 14 There have been studies showing a trend of better trauma patient outcomes with streamlined diversion to definitive centers.15,16 An article in the current issue looks further into the relationship between injury mechanism and the improvement of trauma diversion. 17 Trauma patient care is continuously evolving, and research studies are needed to address the various challenges we face every day.
and Chi-Wai Chau