An Epidemic Within the Pandemic: The Rising Tide of Trauma During COVID-19

Abstract

Background In the age of COVID-19 and enforced social distancing, changes in patterns of trauma were observed but poorly understood. Our aim was to characterize traumatic injury mechanisms and acuities in 2020 and compare to years prior at our Level 1 trauma center. Materials and Methods Trauma patients triaged in 2016 through 2020 from January to May were reviewed. Patient demographics, level of activation (1 vs. 2), ISS, and mechanism of injury were collected. Data from 2016 through 2019 was combined, averaged by month, and compared to data from 2020 using Chi-squared analysis. Results During the months of interest, 992 trauma patients were triaged in 2020 and 4,311 in 2016-2019. The numbers of penetrating and Level 1 trauma activations in January – March of 2020 were similar to average numbers for the same months during 2016 through 2019. In April 2020, there was a significant increase in incidence of penetrating trauma compared to the prior four-year average (27% vs. 16%, p<0.002). Level 1 trauma activations in April 2020 also increased, rising from 17% in 2016 through 2019 to 32% in 2020 (p<0.003). These findings persisted through May of 2020 with similarly significant increases in penetrating and high-level trauma. Conclusion In the months after the initial spread of COVID-19, there was a perceptible shift in patterns of trauma. The significant increase in penetrating and high acuity trauma may implicate a change in population dynamics, demanding a need for thoughtful resource allocation at trauma centers nationwide in the context of a global pandemic.

Racial Disparities Among Trauma Patients During the COVID-19 Pandemic

“…The proportion of patients discharged to post-acute care facilities did not change from PRE to POST (12.3% and 11.3%, respectively; p=0.18), and the race/ethnicity distribution of those who were sent to post-acute care facilities did not change from PRE to POST (p=0. 19). The proportion of patients who were dead on arrival did not change from PRE to POST (0.80% and 0.90%, respectively; p=0.78).…”

“…There is an emerging body of evidence reporting outcome disparities by race/ethnicity related to COVID-19, and outcome disparities by race/ethnicity have long been reported in the trauma literature 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 . Recent studies have also revealed increases in penetrating trauma and mortality among urban trauma centers in the first few months of the pandemic 13 , 15 , 17 , 18 , 19 . Given this data, we hypothesized that patients of color suffered from worse outcomes during the pandemic.…”

“…Recent studies have also revealed increases in penetrating trauma and mortality among urban trauma centers in the first few months of the pandemic 13,15,[17][18][19] . Given this data, we hypothesized that patients of color suffered from worse outcomes during the pandemic.…”

“…Several groups have reported their trauma center experience during the pandemic globally. Some found small changes in the distribution of trauma while several urban centers found significant increases in penetrating trauma [13][14][15][16][17][18][19] . Our own group found significant increases in penetrating and high acuity trauma in the early months of the pandemic 19 .…”

Shift in Prehospital Mode of Transportation for Trauma Patients During the COVID-19 Pandemic

“…Given the overall disruption of COVID-19, we have seen exacerbations of medical issues outside of acute infections of the virus 2 . Interestingly, one such phenomenon has been an increase in patients presenting to Emergency Departments secondary to penetrating traumatic injuries 3 .…”