National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume. Issue 11 (November 2022)

• Record Type: Journal Article
• Authors: Thomas, Arielle C.; Campbell, Brendan T.; Subacius, Haris; Orlas, Claudia P.; Bulger, Eileen; Stewart, Ronald M.; Stey, Anne M.; Jang, Angie; Hamad, Doulia; Bilimoria, Karl Y.; Nathens, Avery B.
• Is Part Of: Injury. Volume 53:Issue 11(2022)
• Page Start: 3655
• Page End: 3662
• Publication Date: 2022-11
• Subjects: COVID-19 -- Trauma epidemiology -- Trauma systems -- Interpersonal violence -- Firearm violence; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.09.012
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: In this retrospective cohort study from centers participating in TQIP, stay-at-home orders were not associated with a decrease in trauma volume. Differences in injury mechanism were driven by an increase in interpersonal violence. The pandemic effect on trauma volume differed by US region, with the Midwest experiencing significantly high admission volumes after levels stabilized. In similar potential future emergencies, hospitals should anticipate increasing trauma care demands, especially in vulnerable populations. Abstract: Background: The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. Methods: All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. Results: There were 166, 773 patients admitted in 2020 after a SAH order and an average of 160, 962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13, 611 (8.3%) vs. 10, 440 (6.6%), p <0.001). Assault injuries increased (19, 056 (11.4%) vs. 15, 605 (9.8%)) and firearm-related injuries (14, 246 (8.5%) vs. 10, 316 (6.4%)), p <0.001. Firearm-specific assault injuries increased (10, 748 (75.5%) vs. 7, 600 (74.0%)) as did firearm-specific unintentional injuries (1, 318 (9.3%) vs. 830 (8.1%), p <0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p <0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, ( p <0.001).