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 Banton; Robert M Madayag; David Hamilton; Therese M Duane; Matthew Carrick; Mark Lieser; Gina Berg; David Bar-Or

doi:10.1136/tsaco-2020-000645

COVID-19 and trauma: how social distancing orders altered the patient population using trauma services during the 2020 pandemic

Trauma Surg Acute Care Open. 2021 Feb 17;6(1):e000645. doi: 10.1136/tsaco-2020-000645. eCollection 2021.

Authors

Casey E Pelzl¹, Kristin Salottolo¹, Kaysie Banton², Robert M Madayag³, David Hamilton⁴, Therese M Duane⁵, Matthew Carrick⁵, Mark Lieser⁶, Gina Berg⁷, David Bar-Or^{1

8}

Affiliations

¹ ION Research, Englewood, Colorado, USA.
² Department of Trauma Surgery, Swedish Medical Center, Englewood, Colorado, USA.
³ Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA.
⁴ Trauma Services Department, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA.
⁵ Trauma Services Department, Medical Center of Plano, Plano, Texas, USA.
⁶ Department of Trauma Services, Research Medical Center, Kansas City, Missouri, USA.
⁷ Department of Trauma Services, Wesley Medical Center, Wichita, Kansas, USA.
⁸ Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.

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 χ² 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.

Keywords: COVID-19; epidemiology; observational study.