Trauma network during COVID-19: perspective from the four designed major trauma centers in north-west Italy

BACKGROUND: In this study we observed the impact of COVID-19 pandemic during March 2020 in four major trauma centers of north-west Italy: ASST Spedali Civili of Brescia (Lombardy), CTO Hospital of Turin (Piedmont region), Circolo Hospital and Macchi Foundation of Varese (Lombardy) and Niguarda Hospital of Milan (Lombardy). METHODS: This retrospective study was realized analyzing data provided by the four hospitals. We observed the impact of lockdown on orthopedics patients on emergency and accident (E&A) departments access, on outpatient visits and on surgical procedures. RESULTS: During the first month of lockdown 2020 patients were admitted for trauma into the four A&E departments examined, with a mean percentage of hospitalization of 26%. 3755 patients were admitted for outpatient visits. 655 surgical procedures were performed. Pure elective procedures were 10% (the majority in the first week of lockdown) while 90% were urgent procedures. We include in these urgent procedures also ontological and spine procedures and postsurgery complications that needed to be taken in charge such as infections and coverage flaps or skin grafts. CONCLUSIONS: The data from the major trauma centers of north-west Italy showed that even there is an undeniable decrease in orthopedics procedures, there are still a certain number of conditions that must be taken in consideration. Trauma center must be identified and protected and, as several authors suggest, teams of anesthetists, orthopedic surgeons and scrub nurses should be trained to operate on patient affected or suspected of COVID-19 positivity.