The Impact of the COVID-19 Pandemic on Hospital Admissions for Trauma and Acute Care Surgery

DiFazio, Louis T.; Curran, Terrence; Bilaniuk, Jaroslaw W.; Adams, John M.; Durling-Grover, Renay; Kong, Karen; Németh, Zoltán

doi:10.1177/0003134820939904

Cited by 52 publications

(70 citation statements)

References 3 publications

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“…The injury-related profile of the patients admitted during the lockdown showed a lower ISS (≤ 15) compared to those in the previous years. Other studies have shown either a similar trend or no change at the time of presentation (DiFazio et al 2020;Jacob et al 2020). As stated by Morris et al (2020), if patients were postponing medical care due to the aforementioned fear, the proportion of mild-moderate injury severity would have decreased in comparison with those with more severe injuries.…”

Section: Discussionmentioning

confidence: 89%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 89%

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

et al. 2021

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“…Most of the current studies on the effect of the stay-at-home orders on trauma patients have reported on changes in mechanism of injury, trauma volume, injury severity, and type of injury, and are typically singlecenter only studies. (Christey et al 2020;DiFazio et al 2020;Lubbe et al 2020;Morris et al 2020;Park et al 2020;Rajput et al 2020;Sutherland et al 2020…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…A current report indicates that patients are more likely to call their primary care provider or the hospital help line before deciding to seek care in the ED during the ongoing pandemic [3]. Early evidence indeed suggests that outpatient, ED visits, and hospital admissions declined by up to 60% from February to April 2020 in some parts of the country, followed by a bounce back after June [2,[8][9][10][11][12][13][14]. However, little is known about the composition of reductions in urgent relative to non-urgent visits.…”

Section: Introductionmentioning

confidence: 99%

Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system

Giannouchos

Biskupiak

Moss

et al. 2021

The American Journal of Emergency Medicine

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Background The coronavirus disease 2019 (COVID-19) pandemic has critically affected healthcare delivery in the United States. Little is known on its impact on the utilization of emergency department (ED) services, particularly for conditions that might be medically urgent. The objective of this study was to explore trends in the number of outpatient (treat and release) ED visits during the COVID-19 pandemic. Methods We conducted a cross-sectional, retrospective study of outpatient emergency department visits from January 1, 2019 to August 31, 2020 using data from a large, urban, academic hospital system in Utah. Using weekly counts and trend analyses, we explored changes in overall ED visits, by patients' area of residence, by medical urgency, and by specific medical conditions. Results While outpatient ED visits were higher (+6.0%) in the first trimester of 2020 relative to the same period in 2019, the overall volume between January and August of 2020 was lower (−8.1%) than in 2019. The largest decrease occurred in April 2020 (−30.4%), followed by the May to August period (−12.8%). The largest declines were observed for visits by out-of-state residents, visits classified as non-emergent, primary care treatable or preventable, and for patients diagnosed with hypertension, diabetes, headaches and migraines, mood and personality disorders, fluid and electrolyte disorders, and abdominal pain. Outpatient ED visits for emergent conditions, such as palpitations and tachycardia, open wounds, syncope and collapse remained relatively unchanged, while lower respiratory disease-related visits were 67.5% higher in 2020 relative to 2019, particularly from March to April 2020. However, almost all types of outpatient ED visits bounced back after May 2020. Conclusions Overall outpatient ED visits declined from mid-March to August 2020, particularly for non-medically urgent conditions which can be treated in other more appropriate care settings. Our findings also have implications for insurers, policymakers, and other stakeholders seeking to assist patients in choosing more appropriate setting for their care during and after the pandemic.

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The Impact of the COVID-19 Pandemic on Hospital Admissions for Trauma and Acute Care Surgery

Cited by 52 publications

References 3 publications

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

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

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

Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system

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