Modern Trends in Nasal Bone Fractures and the Effect of Social Distancing

Abstract

Objectives: To assess differences in demographics, incidence, and cause of nasal bone fractures (NBFs) between pre–coronavirus disease 2019 (COVID-19) and COVID-19 eras. Methods: The National Electronic Injury Surveillance System was queried for adult NBF. Two sample t tests and Wald χ2 tests were used to identify changes across the 2012 to 2019 period and 2020 to 2021 period (age, sex, race, location, disposition, and product). Results: There was a total of 523,259 (95% CI: 445,082–601,436) emergency department (ED)–treated adult NBFs in the United States. There was a greater incidence of NBF during COVID-19 (61,621 annual cases; 95% CI: 61,572–61,669) compared with pre–COVID-19 (50,773 annual cases; 95% CI: 50,195–51,351; P < 0.01). Fewer patients with NBF were discharged after ED evaluation during COVID-19 (79.46%; 95% CI: 74.45%–83.70%) compared with before (84.41%; 95% CI: 82.36%–86.28%; P = 0.049, t test). During COVID-19, there was a decrease in sport-associated NBFs, such as basketball [2.36% (95% CI: 1.71%–3.27%) versus 5.21% (95% CI: 4.20%–6.45%), P < 0.01] and baseball [1.18% (95% CI: 0.82%–1.69%) versus 2.22% (95% CI: 1.80%–2.74%), P<0.01], but an increase in fall (66.34% versus 75.02%), alcohol (7.04% versus 12.89%), and drug-associated (0.47% versus 5.70%) NBFs (all P < 0.001). Conclusion: A greater incidence of NBFs has been observed since the start of the COVID-19 pandemic without significant changes in sex or race. Nasal bone fractures during COVID-19 were less likely to be related to sports or discharged from the ED and more likely to be associated with drugs and alcohol. Changes in sociobehavioral patterns during these unprecedented times may account for post–COVID-19 NBF etiologic drift. Level of Evidence: Level II—retrospective cohort study.