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Open Access

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 Published 17 February 2021
Casey E Pelzl
1ION Research, Englewood, Colorado, USA
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Kristin Salottolo
1ION Research, Englewood, Colorado, USA
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Kaysie Banton
2Department of Trauma Surgery, Swedish Medical Center, Englewood, Colorado, USA
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Robert M Madayag
3Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
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David Hamilton
4Trauma Services Department, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA
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Therese M Duane
5Trauma Services Department, Medical Center of Plano, Plano, Texas, USA
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Matthew Carrick
5Trauma Services Department, Medical Center of Plano, Plano, Texas, USA
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Mark Lieser
6Department of Trauma Services, Research Medical Center, Kansas City, Missouri, USA
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Gina Berg
7Department of Trauma Services, Wesley Medical Center, Wichita, Kansas, USA
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David Bar-Or
1ION Research, Englewood, Colorado, USA
8Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
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    Figure 1

    Patients per day presenting to six US level 1 trauma hospitals before and during the COVID-19 pandemic. SDO, social distancing order.

  • Figure 2
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    Figure 2

    Changes in weekly proportions of age strata among patients presenting to six US level 1 trauma hospitals during the COVID-19 pandemic of 2020.

  • Figure 3
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    Figure 3

    Changes in weekly proportions of injury mechanisms among patients presenting to six U S level 1 trauma hospitals during the COVID-19 pandemic of 2020.

  • Figure 4
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    Figure 4

    Changes in weekly proportions of ISS score ranges among patients at six US level 1 trauma hospitals during the COVID-19 pandemic of 2020. ISS, injury severity scale.

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    Figure 5

    Changes in weekly proportions of trauma activation levels among patients presenting to six US level 1 trauma hospitals during the COVID-19 pandemic of 2020.

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    Figure 6

    Changes in weekly proportions of interhospital transfer patients presenting to six US level 1 trauma hospitals during the COVID-19 pandemic of 2020.

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    Figure 7

    Changes in weekly in-hospital mortality rates at six US level 1 trauma hospitals during the COVID-19 pandemic of 2020.

Tables

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  • Table 1

    Comparisons of patients presenting to six level 1 trauma hospitals during various prepandemic (2019) and midpandemic (2020) time periods

    Time periodPeriod 1Period 1bPeriod 2Period 3
    Year2019201920202020
    DatesJanuary 1–December 31March 16–June 30January 1–March 15March 16–June 30
    Total patients12 797370724883282
    Average patients per day across all six sites35.1 (6.8)***34.6 (6.8)**33.2 (7.0)30.7 (8.4)
    Age ≥65 years, % (n)42.9 (5496)41.4 (1536)44.8 (1114)*40.9 (1341)
    Female, % (n)42.9 (5487)41.9 (1553)44.4 (1104)41.2 (1351)
    Race, % (n)
     White76.5 (9796)75.6 (2803)76.2 (1895)74.8 (2454)
     Black10.1 (1287)10.5 (390)9.5 (237)10.4 (342)
     Asian1.6 (202)1.5 (56)1.7 (41)1.6 (53)
     American Indian0.7 (88)0.7 (27)1.0 (25)0.8 (27)
     Native Hawaiian1.0 (131)1.1 (39)1.4 (35)1.7 (55)
     Other/unknown/undocumented10.1 (1293)10.6 (392)10.3 (255)10.7 (351)
    Injury type, % (n)*****
     Blunt89.6 (11 461)89.4 (3 314)89.7 (2 232)87.1 (2,857)
     Penetrating6.9 (884)7.3 (269)6.7 (168)9.4 (308)
     Other/undocumented3.5 (452)3.4 (124)3.5 (88)3.6 (117)
    Injury severity, % (n)*
     ISS ≤1583.1 (10 637)82.5 (3057)85.2 (2119)81.8 (2685)
     ISS 16–249.8 (1253)10.5 (391)9.0 (223)10.5 (343)
     ISS ≥257.1 (907)7.0 (259)5.9 (146)7.7 (254)
    Level of trauma team activation, % (n)*********
     Full/requires immediate response15.1 (1936)16.1 (597)13.7 (340)16.4 (538)
     Partial/requires non-immediate response29.3 (3746)31.0 (1149)26.3 (655)27.9 (915)
     Consult/requires eventual response8.3 (1064)8.1 (301)16.2 (404)18.3 (600)
     None/no trauma surgeon required34.9 (4460)32.3 (1197)30.9 (769)24.8 (814)
     Other/unlisted12.4 (1591)12.5 (463)12.9 (320)12.6 (415)
    Interhospital transfers, % (n)33.3 (4258)33.3 (1236)36.7 (912)***31.6 (1036)
    ED discharge disposition, % (n)*
     Died0.5 (69)0.5 (18)0.4 (10)0.7 (24)
     ICU24.9 (3180)25.9 (959)24.1 (599)24.0 (787)
     OR/IR8.1 (1033)8.9 (330)7.8 (193)9.2 (303)
     Floor/stepdown/observation52.1 (6671)49.9 (1849)53.9 (1341)52.2 (1714)
     Left hospital (transfer/home)10.1 (1292)10.8 (399)10.0 (248)10.8 (355)
     Other/undocumented4.3 (552)4.1 (152)3.9 (97)3.0 (99)
    In-hospital mortality, % (n)3.3 (421)***3.2 (119)**3.3 (82)*4.2 (137)
    HLOS, median (IQR), days3.0 (1.6–6.0)***3.0 (1.0–5.9)3.0 (1.7–6.0)3.0 (1.0–5.0)
    ICULOS, median (IQR), days0.0 (0.0–2.0)0.0 (0.0–2.0)0.0 (0.0–2.0)0.0 (0.0–2.0)
    • Level of statistically significant difference from period 3: *p<0.01; **p<0.001; ***p<0.0001. Combining percents may not equal 100% due to rounding.

    • d, days; ED, emergency department; HLOS, hospital length of stay; ICULOS, intensive care unit length of stay; IR, interventional radiology; ISS, injury severity scale; OR, operating room.

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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
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000645; DOI: 10.1136/tsaco-2020-000645

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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
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000645; DOI: 10.1136/tsaco-2020-000645
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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
Trauma Surgery & Acute Care Open Feb 2021, 6 (1) e000645; DOI: 10.1136/tsaco-2020-000645
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