COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients
Eric O. Yeates, Areg Grigorian, Morgan Schellenberg, Natthida Owattanapanich, Galinos Barmparas, Daniel R. Margulies, Catherine Juillard, Kent Garber, Henry Cryer, Areti Tillou, Sigrid Burruss, Ryan Arthur Figueras, Georgi Mladenov, Megan Brenner, Christopher Firek, Todd W. Costantini, Jarrett Santorelli, Terry Curry, Diane Wintz, Walter L. Biffl, Kathryn B. Schaffer, Thomas K. Duncan, Casey Barbaro, Graal Diaz, Arianne Johnson, Justine Chinn, Ariana Naaseh, Amanda Leung, Christina Grabar, Jeffry Nahmias
Abstract
PURPOSE: There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients. METHODS: A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups. RESULTS: A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients. CONCLUSION: This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.