Major trauma cases down but domestic violence up during COVID-19 lockdown

During the COVID-19 lockdown period, major trauma cases such as road traffic accidents and worksite injuries have decreased while the opposite is true for interpersonal violence, which has shown a relative increase, according to a Singapore study.

“Redeployment of manpower and hospital resources may have contributed to decreased usage of trauma workflows and community facilities,” the researchers said.

“In the event of further lockdowns, it is necessary to plan for trauma coverage and maintain the use of workflows to facilitate early intervention,” they added.

The national trauma registry was used to carry out this retrospective analysis of cases comparing the lockdown period (from 7 February 2020 to 1 June 2020) to the prelockdown period (from 7 February 2019 to 1 June 2019).

Subsequently, the researchers extracted data including the volume of tier 1 (injury severity score [ISS] >15) and tier 2 (ISS 9‒15) cases and epidemiology. They also conducted a subgroup analysis for tier 1 patient outcomes.

A 19.5-percent decrease in trauma volume was recorded, including a 32-percent reduction in tier 1 cases. Road traffic and workplace accidents decreased by half (50 percent; p<0.01), but interpersonal violence rose by 37.5 percent (p=0.34). [Singapore Med J 2023;64:677-682]

“The downtrend in rates of traffic-related and workplace trauma can be attributed to the direct effects of the nationwide lockdown decreasing traffic flow and the closure of work sites,” the researchers said. [BMJ 2020;369:m1401]

Usage of trauma workflows also decreased by as much as 18.1 percent (p=0.01), while time to intervention for tier 1 patients increased from 88 to 124 min (p=0.22). Additionally, the proportion of patients discharged to community facilities dropped from 31.4 percent to 17.1 percent (p<0.05).

On the other hand, no increase was observed in inpatient mortality, length of stay in critical care, or length of stay overall.

Domestic violence

A 2020 study also reported an increase in interpersonal violence during the COVID-19 pandemic. The cause of this increase was not covered by the scope of the current study. [Ann Surg 2020;272:e53-54]

However, records from other countries reported a rise in partner violence and in trends of self-harm during the period of enforced social isolation. This reflected an overall increase in anxiety and depression in the public. [Psychol Trauma 2020;12(Suppl 1):S199-201; Br J Psychiatry 2020;217:543-546; Singapore Med J 2022;63:229-235]

Other countries have raised the issue of addressing the mental health of the public and reaching out to vulnerable groups, including telehealth visits focusing on domestic violence in Australia and development of remote assessment and care pathways for patients at risk of self-harm. [Aust J Gen Pract 2020;doi:10.31128/AJGP-COVID-25; Lancet Psychiatry 2020;7:468-471]

“[T]he COVID-19 lockdown period showed a decrease in major trauma admissions and a change in injury trends,” the researchers said. “There should be adequate pandemic preparedness planning locally in the event of a second wave of lockdowns, which should highlight that there is still a substantial need for the provision of full trauma services within hospitals, unless resource limitations make it unavoidable.”