Traumatic Injury Under COVID-19 Stay-at-Home Advisory: Experience of a New England Trauma Center

Abstract

BACKGROUND With the onset of the COVID-19 pandemic and subsequent widespread stay-at-home advisories throughout early 2020, hospitals have noticed a decrease in illnesses unrelated to COVID-19. However, the impact on traumatic injury is relatively unknown. This study aims to characterize patterns of trauma during the COVID-19 pandemic at a Level I Trauma Center. MATERIALS & METHODS A retrospective review was performed of adult trauma patients from March through June, in the years 2018 through 2020. Primary outcome was the number of trauma activations (volume). Secondary outcomes included activation level, mechanism of injury, mortality rate, and length of stay, and other demographic background. Trauma patterns of the 2018 and 2019 periods were combined as historical control, and compared to patterns of the biweekly-matched period of 2020. RESULTS A total of 2,187 patients were included in analysis (Pre-COVID n = 1,572; COVID n = 615). Results were significant for decreased trauma volume but longer length of stay during COVID cohort, and for an increased proportion of males. No significant difference was found for other demographic variables, trauma mechanisms, or severity. Trauma volume patterns mirrored COVID rates in the state. CONCLUSIONS Despite a decline in trauma volume, other trauma patterns including severity and mechanism remained unchanged during the COVID-19 period. The decreased volume was not associated with a markedly lower clinical workload, change in team structure, or provider coverage re-distribution. Our data suggests that trauma volume and severity remained high enough during COVID-19 peak to necessitate full staffing, which may provide guidance in the event of a pandemic resurgence.

Impact of COVID‐19 pandemic on trauma mortality patients: A retrospective observational study in an Iranian level 1 trauma center

“…Multiple studies examining trauma during COVID‐19 have reported a drop in the number of minor injuries and a reduction in MVAs. 40 , 41 , 42 , 43 , 44 , 45 Despite this, studies focusing on patients with more severe injuries have reported that severe injury mechanisms in the COVID‐19 era remain similar to pre‐COVID‐19 era; our study includes only mortality patients, a population who naturally had sustained more severe injuries and its findings are consistent with previously published studies focusing on severe trauma. 15 , 46 , 47 …”

“…39 Multiple studies examining trauma during COVID-19 have reported a drop in the number of minor injuries and a reduction in MVAs. [40][41][42][43][44][45] Despite this, studies focusing on patients with more severe injuries have reported that severe injury mechanisms in the COVID-19 era remain similar to pre-COVID-19 era; our study includes only mortality patients, a population who naturally had sustained more severe injuries and its findings are consistent with previously published studies focusing on severe trauma. 15,46,47 The arrival mode of patients to our center showed significant changes in the pandemic period, with a higher number being transported by EMS/HEMS and transferred from other facilities, and a lower number period.…”

Effect of the COVID‑19 pandemic on the management and outcomes of patients with traumatic injuries (Review)

“…Studies indicated a general increase in injuries caused by assault and self-harm, with similar results regarding other injury mechanisms such as sports-related injuries ( 23-26 ) and other less common mechanisms. However, a statistically significant increase in cases of firearm-related injuries and intentional or accidental stabbings was observed [for instance, a significant increase in gun-related injuries was observed, 6 vs. 9%, in a study by Mokhtari et al ( 27 )]; most of the findings in the present study came from studies conducted in the USA, where firearm legislation is more relaxed ( 23-43 ).…”

Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center

“…The current literature on trauma volume and distribution during the pandemic varies by site with some sites having similar overall volume, 39 some with stable volume and increased penetrating percentage, 15 , 16 and others having overall decreased volume but increased rates of penetrating injury. 11 , 14 This study's results fit into the second group, and despite relative increased penetrating volume by 32%, and 25% increase in requiring initial operative intervention, mortality remained stable at 3.7%.…”