How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

Abstract

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

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%.…”

“…Several trauma centers saw decreased overall and blunt volume by up to 22% 11 but increased penetrating rates by up to 30% and increased severity of presentation. 12 , 13 , 14 , 15 , 16 In other countries the pandemic was associated with decreased intensive care unit (ICU) admission and increased mortality in traumatic brain injury subgroups, 17 however the trauma mortality rate in large US series was similar to pre-pandemic levels. 15 , 16 Additionally, emergency surgical conditions continued to present, and some evidence demonstrated later presentation and increased severity, possibly due to fear of COVID exposure or overutilizing the already taxed medical system.…”

“… 12 , 13 , 14 , 15 , 16 In other countries the pandemic was associated with decreased intensive care unit (ICU) admission and increased mortality in traumatic brain injury subgroups, 17 however the trauma mortality rate in large US series was similar to pre-pandemic levels. 15 , 16 Additionally, emergency surgical conditions continued to present, and some evidence demonstrated later presentation and increased severity, possibly due to fear of COVID exposure or overutilizing the already taxed medical system. 18 , 19 While EGS trends in utilization, volume, severity, and outcomes varied by country and region during the pandemic, 20 , 21 , 22 , 23 , 24 , 25 , 26 it is clear that emergency presentations and operations still occurred at high levels compared to elective surgical counterparts.…”

How the COVID-19 Pandemic Affected Attendance at a Tertiary Orthopedic Center Emergency Department: A Comparison between the First and Second Waves

“…On the other hand, there are also papers describing mixed situations. For example, Hahn et al report no significant difference in the admissions for minor trauma during 2020 compared with the years prior to the COVID-19 pandemic (2017–2019) [ 27 ]. For greater clarity, the discharge diagnosis of “malaise” includes patients presenting with general symptoms of physical discomfort and dizziness (with or without syncope) but without imaging evidence of critical conditions (e.g., without evidence of bleeding or stroke at CT scan).…”

The COVID-19 pandemic and its impacts on mass shootings in six major US cities

“…Despite a decrease in trauma center volume, a rise in penetrating trauma from firearms has been observed in major United States cities during the COVID-19 pandemic. [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] These changes in gun violence during the lockdown from the pandemic could be attributable to financial insecurity, housing instability, and social isolation. [ 9 , 10 ] An increase in gun sales in the United States has also been reported.…”