Impact of the COVID-19 Pandemic on road traffic collision injury patterns and severity in Al-Ain City, United Arab Emirates

Abu Dhabi Health Research and Technology Ethics Committee, The Department of Health, Abu Dhabi Emirate, gave ethical approval for this study (Ref: DOH/CVDC/2021/650).

A comparative retrospective analysis of prospectively collected data of two cohorts of patients. The first cohort was the hospitalized RTC trauma patients of Al-Ain City for the year before the COVID-19 Pandemic who died or were followed up to discharge from the hospital, and the second cohort was the hospitalized RTC trauma patients of Al-Ain City in the first year of the COVID-19 Pandemic who died or were followed up to discharge from the hospital.

Al-Ain City is the second-largest city in Abu Dhabi Emirate, UAE. It has an estimated population of 766,009 [7]. The city has two major hospitals that received trauma emergencies prior to the COVID-19 Pandemic (Al-Ain and Tawam Hospitals). Following the outbreak of the COVID-19 Pandemic, Al-Ain Hospital was designated on 28 March 2020 as the COVID-19 hospital, and it stopped receiving trauma patients. Tawam hospital was designated a non-COVID hospital and was the only trauma receiving hospital during the Pandemic.

All RTC trauma patients who died in the hospital or who were admitted at both Al-Ain and Tawam hospitals from 28 March 2019 to 27 March 2020 (pre-pandemic period) and those who died in the hospital or who were admitted to Tawam hospital from 28 March 2020 to 27 March 2021 (Pandemic period) were studied. During the Pandemic period, all trauma patients that presented to Tawam Hospital (the non-COVID-19 hospital) were screened by a reverse transcriptase-PCR COVID-19 test on arrival to the Emergency Department. They would be continuously managed in the Emergency Department till the PCR result comes back. They would be admitted to Tawam Hospital only if the PCR result was negative which would take around 4 h. If the test was positive, they would be directly transferred to Al-Ain Hospital (the COVID-19 hospital) for further care. If a trauma patient needs an urgent life-saving or limb saving surgery, then this procedure will be performed in Tawam Hospital under strict personnel protective equipment and disinfection precautions without waiting for the PCR result. The patient will wait in the operating recovery room till the PCR result is received to decide whether to admit the patient to Tawam Hospital or transfer him/her to Al-Ain Hospital.

Data were retrieved from the Abu Dhabi Trauma Registry. This is the National Registry of Abu Dhabi Emirate, which started in 2013 and collects data from 8 hospitals from Abu-Dhabi Emirate. The Abu Dhabi Trauma Registry is based on the National Trauma Database of the American College of Surgeons. Data are collected prospectively, coded, and entered by full-time trained registry nurses.

Studied variables in both periods (pre-COVID period and the Pandemic period) included demography, mechanisms of injury, physiological and anatomical severity markers, ISS, hospital and ICU admission, length of stay, and death.

Data are presented as number (percentage) for categorical data, median (range) for ordinal data, and mean (standard deviation) for continuous data. Fisher’s Exact test was used to compare the categorical data of two independent groups, while Mann–Whitney U test was used to compare continuous or ordinal data of two independent groups when performing a univariate analysis.

Trauma mortality depends on numerous predicting factors. Finding statistical significance in a single independent predicting factor in a univariate analysis is not enough to indicate that this factor is a predictor of mortality. It can be simply a confounder of another factor. Multivariate logistic regression models will address this concern if we want to know whether the Pandemic actually increased the mortality of hospitalized RTC trauma patients [12]. Accordingly, factors that had a loose p value of less than 0.1 in the univariate comparison between those who died and those who survived were entered into a backward logistic regression model. Statistical Package for the Social Sciences (IBM-SPSS version 26, Chicago, Il) was used for all analyses. A p value of less than 0.05 was accepted as significant.

We acknowledge that our study has certain limitations. First, the reduction of RTC patients during the COVID-19 Pandemic may not be solely due to COVID-19 lockdown measures but as a continuation of the decreasing trend of RTCs in our city over the last decade [36]. Second, our study is from a single city in UAE and may not represent the whole UAE. Third, our study did not include RTC trauma patients treated in the emergency department who were discharged home nor those having minor injuries who did not seek medical advice and those who died on the scene. Fourth, our study was short of proving that the Pandemic increased mortality of RTCs despite the strong trend due to the relatively small sample size. Finally, the detailed mechanism of the RTCs and environmental conditions, like the speed of the vehicles, were not available.