The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

Abstract

Background The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital. Methods An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05. Results A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS. Conclusions Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.

Factors affecting 30-day postoperative complications after emergency surgery during the COVID-19 outbreak: A multicentre cohort study

“…The increase in trauma surgical procedures occurred in the second half of the first wave of the COVID-19 pandemic. This increase may result from an increase in falls and household injuries, which was seen in other studies ( 25 , 26 , 27 ). Additionally, an increase in bicycle accidents during the lockdown, as described previously, may be attributed to the increase in surgical trauma procedures as well ( 27 ).…”

Injury Mechanism, Volume, and Severity of General Surgical Trauma Patients During COVID-19 Lockdown

“…When considering mortality rates, we found no significant difference between the groups. This finding was consistent with other studies in the literature [ 7 , 12 , 15 , 16 ]. Also, ICU admissions and surgical intervention rates were similar in this study.…”

“…But Yeates et al found an increase in gunshot wounds after COVID-19 stay-at-home advisories [ 15 ]. In another study conducted on this subject, it was emphasized that traumas due to falls increased and other trauma mechanisms decreased during the COVID-19 pandemic [ 16 ].…”

Falls Injuries and Anxiety among Community-Dwelling Older Adults in the Midst of COVID-19 Lockdown Restrictions: Are these Helpful or Harmful?

“…Another current 2021 report has likewise shown that there has been an increase in home injuries over the pandemic period, and that falls remained the dominant mechanism of injury in 2020 in this regard, contributing 39.9% of all hospitalizations according to Christey et al [9]. Ruiz-Medina et al [10] too reported falls rates to have experienced a significant increase during the lockdown period (18.9% vs. 26.7%; p = 0.026).…”