LAUSR

Study Objective: Early articles published during the first few months of the COVID-19 pandemic indicated declines in traumatic injuries in the U.S. and internationally. Throughout 2020, there were numerous governmental stay-home orders and policies, health care responses, and COVID-19 vaccine development;all of which may have had unintended consequences beyond illness prevention. Here we investigate the longer-term impact over the first year of the pandemic on the incidence of traumatic injuries. Methods: This retrospective analysis was performed with all records of trauma activations from an urban level 1 trauma center’s trauma registry. Mean weekly, monthly, and total yearly patient counts from 2017-2019 and total from 2020 were compared using independent samples t-test or Mann-Whitney U test. Shapiro-Wilk and Levene’s tests were used to assess normality and variances, respectively. Differences were considered significant when two-sided p-value < 0.05. Results: Of 4157 trauma patients in 2020, 73% were male and average age was 39 years old. There were more trauma patients in 2020 than the 2017-2019 average (n = 3869). No demographic differences were present comparing patients seen in 2020 and those of previous years. In 2020, there were significantly higher weekly counts of penetrating injuries versus the 2017-2019 average (mean [SD]) (22.5 [7.2] vs 17.5 [3.1], p > 0.000), specifically gunshot wounds (GSWs) (15.8 [6.0] vs. 11.3 [2.7], p > 0.0000) and more assaults (23.3 [6.7] vs 19.4 [3.2], p > 0.0003). In 2020, fewer falls (11.9 [4.3] vs. 13.4 [2.5], p > 0.03), pedestrian/bicycle accidents (5.5 [3.1] vs 7.5 [2.1], p > 0.0002) and accidents in general (45.9 [17.1] vs 50.9 [5.6], p > 0.0003) presented to our hospital compared to 2017-2019 average. Monthly totals in 2020 were higher than average in every month except those with strictest stay home mandates in place (March-May). Overall, weekly totals were higher than average in 2020 (79 vs 73) and decreased during the strictest shut-downs from March 18 through the beginning of June (Fig. 1A & B). Conclusion: A decreased number of traumatic injuries presented to our level 1 trauma center during the first six weeks of the pandemic, which coincided with closure of most non-essential businesses and the strictest government-instituted stay home orders. The week that our state and city moved into re-opening of businesses to 50% capacity and opened bars, there were more traumatic injuries than previous years on average. After that initial week of increased patient volume, weekly counts of trauma patients were above average in most (25 / 31, 80%) weeks through the end of the year. Increased GSWs and assaults this year may suggest increased interpersonal conflict due to external stressors caused by the pandemic. Conversely, decreased falls, pedestrian/bike accidents and other causes of accidents may suggest that staying at home decreases activities and associated accident risk.