Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers

Abstract

Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.

Trauma trends during COVID‐19 alcohol prohibition at a South African regional hospital

“…A major rationale for alcohol prohibition during the COVID‐19 lockdown was to decrease the volume of persons with injury needing non‐COVID‐19 medical intervention, to create beds for COVID‐19 patients [11]. In the USA where alcohol was not banned, there was an increase in alcohol‐related trauma with risk factors possibly being stress and stay at home orders [23]. Since alcohol‐related trauma can account for up to 40% of emergency department visits in SA, identifying policies to reduce injuries is paramount to free up space for hospitals to treat patients with COVID‐19 who are also competing for ward beds, intensive care unit beds, ventilators, medical supplies and attention from doctors, nurses and other hospital staff [9].…”

Examining trends in gun violence injuries before and during the COVID-19 pandemic across six trauma centers

“…After high stress events such as national emergencies, studies tend to show increases in firearm purchases, as well as an uptick in anxiety, depression, and acute stress disorder. 7 13 Following the official recognition of the COVID-19 pandemic, firearm sales skyrocketed, 9 14 and so did the number of people with mental illness and substance use disorders, 2 creating a vulnerable and unique patient profile across hospitals in the USA. This study examined the effect of the stay-at-home orders on characteristics and rate of GSW admissions across level I trauma centers.…”

“…Social distancing guidelines were recommended for 15 days and then subsequently extended until April 30, 2020 (CNN 2020). Though stay-at-home orders are a long-standing public health tool to curtail infection spread, 1 they have led to unforeseen consequences across patient populations including increases in substance abuse, 2 3 mental illness, 4 and assaults. 5 More specifically, there has been a surge in penetrating trauma by gun violence across many trauma centers, 6 7 potentially due to a surge in firearm sales during the COVID-19 pandemic.…”

Evaluating the change in patterns of traumatic injury in the setting of pandemic and social distancing restrictions: An analysis of a level 1 trauma center

“…Though there is variability, it appears that the pandemic has exacerbated the behavior of some of those with underlying substance abuse disorders. 8 …”