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Open Access

Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures

Kristin Salottolo, Rachel Caiafa, Jalina Mueller, Allen Tanner, Matthew M Carrick, Mark Lieser, Gina Berg, David Bar-Or
DOI: 10.1136/tsaco-2020-000655 Published 2 April 2021
Kristin Salottolo
1Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
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Rachel Caiafa
2Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
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Jalina Mueller
3Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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Allen Tanner
4Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
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Matthew M Carrick
5Medical 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
7Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA
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David Bar-Or
3Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
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  • Figure 1
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    Figure 1

    Incidence (%) of the three most common causes of injury, by surveillance week and pandemic period. (A) Incidence of falls; (B) incidence of motor vehicle crashes; and (C) incidence of assaults.

Tables

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  • Table 1

    Demographics by study period

    Covariate, % (n)Prepandemic
    March 11, 2019–June 30, 2019
    n=3862
    Pandemic
    March 11, 2020–June 30, 2020
    n=3446
    P value
    Mean (SD) age, years54.4 (22)53.9 (21)0.32
    Female sex42.0 (1621)41.4 (1427)0.63
    White race75.8 (2926)74.7 (2575)0.43
    Full/partial trauma activation16.0 (619)16.3 (560)0.80
    ED disposition: operating room9.6 (371)10.0 (344)0.59
    ED SBP <90 mm Hg4.3 (164)4.7 (163)0.32
    Injury severity score ≥1617.7 (685)18.1 (625)0.66
    Severe injury, AIS ≥3
     Head trauma14.9 (575)15.6 (539)0.37
     Thoracic trauma13.0 (503)13.7 (471)0.42
     Abdomen/pelvic trauma3.2 (125)3.3 (114)0.86
     Upper extremity trauma1.2 (45)1.6 (55)0.11
     Lower extremity trauma18.1 (698)18.8 (647)0.44
    In-hospital mortality3.2 (125)4.7 (163)0.001
    Hospital LOS, median (IQR)3 (1.2–6)3 (1–5)0.02
    ICU LOS, median (IQR)2 (0–3)1 (0–3)0.002
    • Bolding denotes statistical significance with p<0.05.

    • AIS, Abbreviated Injury Scale; ED, emergency department; ICU, intensive care unit; LOS, length of stay; SBP, systolic blood pressure.;

  • Table 2

    Causes of injury by study period

    Covariate, % (n)Prepandemic
    March 11, 2019–June 30, 2019
    n=3862
    Pandemic
    March 11, 2020–June 30, 2020
    n=3446
    P value
    Fall42.2 (1630)43.8 (1508)0.18
    Motor vehicle crash17.0 (657)14.0 (481)<0.001
    Assault6.9 (265)8.5 (294)0.01
    Motorcycle crash5.1 (198)5.6 (193)0.37
    Worksite injury5.2 (202)4.1 (141)0.02
    Crush/strike4.0 (156)3.2 (111)0.06
    Bicycle2.8 (107)4.2 (146)<0.001
    Home improvement3.3 (127)3.3 (115)0.91
    Pedestrian3.0 (116)2.2 (74)0.02
    Recreational3.0 (116)1.7 (58)<0.001
    Off-road vehicles1.8 (68)3.0 (103)<0.001
    Firearm1.1 (44)1.5 (52)0.17
    Self-inflicted1.2 (46)1.3 (45)0.66
    Other*3.4 (130)3.6 (125)0.54
    • *Other: burn (n=98), animal bite (n=59), glass/sharp object (n=38), 'other' (n=35) or unknown (n=25).

  • Table 3

    Injury characteristics and outcomes by cause of injury

    CauseTrauma activation, % (n)ED to OR, % (n)ISS ≥16, % (n)Head AIS ≥3 (severe), % (n)ED SBP <90 mm Hg, % (n)Mortality, % (n)
    Fall6.2 (195)5.1 (158)13.2 (413)18.0 (566)3.4 (108)3.5 (112)
    Motor vehicle crash21.0 (239)8.5 (97)24.7 (281)10.6 (121)4.4 (50)4.6 (52)
    Assault46.7 (261)22.4 (125)19.1 (107)11.3 (63)7.9 (44)3.6 (20)
    Motorcycle crash26.6 (104)14.3 (56)28.9 (113)17.4 (68)7.7 (30)7.2 (28)
    Worksite injury14.3 (49)18.9 (68)17.5 (60)14.3 (49)6.1 (21)1.2 (4)
    Crush/strike5.6 (15)8.2 (22)13.1 (35)18.4 (49)1.5 (4)1.9 (5)
    Bicycle7.5 (19)6.7 (17)17.4 (44)14.2 (36)3.2 (8)2.8 (7)
    Home improvement9.1 (22)17.4 (42)19.8 (48)9.1 (22)2.5 (6)2.1 (5)
    Pedestrian31.1 (59)8.4 (16)28.4 (54)22.6 (43)9.0 (17)6.3 (12)
    Recreational14.4 (25)9.2 (16)26.4 (46)12.1 (21)1.2 (2)0.6 (1)
    Off-road vehicles15.8 (27)5.9 (10)19.3 (33)11.7 (20)2.9 (5)0.6 (1)
    Firearm60.4 (58)19.8 (19)20.8 (20)10.4 (10)7.3 (7)10.4 (10)
    Self-inflicted71.4 (65)29.7 (27)31.9 (29)28.6 (26)16.5 (15)24.2 (22)
    Other16.1 (41)16.5 (42)10.6 (27)7.8 (20)3.9 (10)2.5 (9)
    P value*<0.001<0.001<0.001<0.001<0.001<0.001
    • *P value denotes significant differences in the injury characteristic/outcome by cause of injury.

    • AIS, abbreviated injury scale; ED, emergency department; ISS, injury severity score; OR, operating room; SBP, systolic blood pressure.

  • Table 4

    Specific injury diagnoses: 10 most common reported in the population

    ICD-10 code – descriptionPrepandemic
    March 11, 2019–June 30, 2019
    N=3862, % (n)
    Pandemic
    March 11, 2020–June 30, 2020
    N=3446, % (n)
    P value
    Superficial injury* of head23.0 (863)27.3 (918)<0.001
    Intracranial injury (TBI)25.1 (943)24.1 (812)0.37
    Fracture of rib(s), sternum and thoracic spine22.2 (832)21.1 (707)0.26
    Open wound of head15.8 (630)17.9 (599)0.23
    Femur fracture14.6 (549)16.0 (536)0.11
    Fracture of lumbar spine and pelvis14.6 (548)13.1 (440)0.07
    Fracture of skull and facial bones13.6 (511)12.9 (433)0.38
    Superficial injury of knee and lower leg11.7 (440)14.9 (499)<0.001
    Intrathoracic organ injury – other/unspecified11.1 (417)11.5 (387)0.57
    Fracture of lower leg, including ankle9.5 (355)10.2 (342)0.30
    • Note: 83% of patients had one of the 10 most common injury diagnoses.

    • *For example, contusion, abrasion, blister and bite to head (scalp, eye, nose, ear, cheek and mouth).

    • TBI, Traumatic Brain Injury.

  • Table 5

    Procedure types and 10 most common medical/surgical procedures reported in the population

    Procedure grouping by ICD-10 codes
    (with examples)
    Prepandemic
    March 11, 2019–June 30, 2019
    n=3862, % (n)
    Pandemic
    March 11, 2020–June 30, 2020
    n=3446, % (n)
    P value
    Imaging (CT scan, X-ray)91.1 (3488)90.6 (3082)0.51
    Administration (blood products and therapeutics)31.4 (1201)34.2 (1165)0.01
    Placement (packing and immobilization)24.3 (931)24.3 (827)0.99
    Measure and monitor (ICP monitor)11.0 (421)12.9 (438)0.01
    Medical/surgical procedures (repair/replace)57.5 (2201)61.9 (2106)<0.001
     Lower bone18.8 (718)19.8 (673)0.26
     Skin15.7 (602)17.0 (579)0.13
     Upper bone9.0 (344)9.9 (338)0.17
     General anatomic*6.9 (264)8.3 (282)0.02
     Respiratory7.5 (288)8.4 (284)0.19
     Subcutaneous/fascia6.1 (235)7.8 (265)0.01
     Lower joints8.1 (312)9.4 (318)0.07
     Gastrointestinal3.9 (149)4.2 (144)0.46
     Upper joints4.0 (153)4.5 (152)0.32
     Head and face3.1 (120)3.2 (110)0.81
    • Sixty percent of patients had one of the 10 most common medical/surgical procedures.

    • *For example, hemorrhage control, excision and drainage, tube change and biopsy.

    • ICP, Intracranial Pressure Monitor.

Supplementary Materials

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  • Supplementary data

    [tsaco-2020-000655supp001.pdf]

Additional Files

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures
Kristin Salottolo, Rachel Caiafa, Jalina Mueller, Allen Tanner, Matthew M Carrick, Mark Lieser, Gina Berg, David Bar-Or
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000655; DOI: 10.1136/tsaco-2020-000655

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Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures
Kristin Salottolo, Rachel Caiafa, Jalina Mueller, Allen Tanner, Matthew M Carrick, Mark Lieser, Gina Berg, David Bar-Or
Trauma Surg Acute Care Open Apr 2021, 6 (1) e000655; DOI: 10.1136/tsaco-2020-000655
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Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures
Kristin Salottolo, Rachel Caiafa, Jalina Mueller, Allen Tanner, Matthew M Carrick, Mark Lieser, Gina Berg, David Bar-Or
Trauma Surgery & Acute Care Open Apr 2021, 6 (1) e000655; DOI: 10.1136/tsaco-2020-000655
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