COVID-19 and trauma: how social distancing orders altered the patient population using trauma services during the 2020 pandemic
Casey E. Pelzl, Kristin Salottolo, Kaysie L. Banton, Robert Madayag, David Hamilton, Therèse M. Duane, Matthew Carrick, Mark J. Lieser, Gina M. Berg, David Bar‐Or
Abstract
Background Recent studies have reported changes in trauma volumes resulting from the COVID-19 pandemic and social distancing orders (SDOs) implemented by federal and state governments. However, literature is lacking on demographic, injury and outcome patterns. Methods This retrospective, cross-sectional study included patients aged ≥18 years at six US level 1 trauma centers. Patients not discharged by the date of data acquisition were excluded. Demographic, injury and outcome variables were assessed across four time periods: period 1 (January 1, 2019–December 31, 2019); period 1b (March 16, 2019–June 30, 2019); period 2 (January 1, 2020–March 15, 2020); and period 3 (March 16, 2020–June 30, 2020). Patients admitted in period 3 were compared with patients presenting during all other periods. Categorical data were compared with χ 2 and Fisher’s exact tests, and continuous data were assessed with Student’s t-tests and Wilcoxon rank-sum tests. Results We identified 18 567 patients: 12 797 patients in period 1 (including 3707 in period 1b), 2488 in period 2 and 3282 in period 3. Compared with period 1, period 3 had a statistically significant decrease in mean patient volume, increase in portion of penetrating injuries, increase in higher levels of trauma activation, change in emergency department discharge disposition locations, increase in in-hospital mortality and a shorter hospital length of stay. Comparison between period 1b and period 3 demonstrated a decrease in mean patient volume, increase in penetrating injuries, increase in high acuity trauma activations and increase in in-hospital mortality rate. From period 2 to period 3, the penetrating injuries rose from 6.7% to 9.4% (p=0.004), injury severity scale ≥25 increased from 5.9% to 7.7% (p=0.002), full trauma team activations increased from 13.7% to 16.4% (p<0.001), interhospital transfers decreased from 36.7% to 31.6% (p<0.001) and the in-hospital mortality rate increased from 3.3% to 4.2% (p=0.003). Discussion Beyond altering social interactions among people, the federal SDO is associated with changes in trauma volumes, demographics and injury patterns among patients seeking care at six level 1 hospitals during the pandemic. Level of evidence IV, prognostic and epidemiological.