LAUSR

Background Public health measures were instituted to reduce COVID-19 spread. A decrease in total emergency department (ED) volume followed, but the impact on injury is unknown. With lockdown and social distancing potentially increasing domicile discord, we hypothesized that intentional injury increased during COVID-19 primarily driven by an increase in penetrating trauma. Study Design A retrospective review of acute adult patient care in an urban, level 1 trauma center assessed injury patterns. Presenting patient characteristics and diagnoses from 6 weeks pre- to 10 weeks post- a statewide stay-at-home order (SAHO, 3/16/2020) were compared; as well as to 2015- 2019. Subsets were defined by intentionality (intentional vs. non-intentional) and mechanism of injury (MOI, blunt vs. penetrating). Fisher exact and Wilcoxon tests were used to compare proportions and means. Results 357 and 480 trauma patients presented pre- and post-SAHO, respectively. Pre and post groups demonstrated differences in sex (35.6% vs. 27.9% female, p = 0.02), age (47.4 ± 22.1 vs. 42 ± 20.3, p = 0.009), and race (1.4% vs. 2.3% Asian; 63.3% vs. 68.3% Black; 30.5% vs. 22.3% White; 4.8% vs. 7.1% Other; p=0.03). Post-SAHO MOI revealed more intentional injury (p=0.0008). Decreases in non-intentional trauma after adoption of social isolation paralleled declines in daily ED visits. Compared to prior years, 2020 demonstrated a significantly greater proportion of intentional violent injury during the peri-pandemic months, especially from firearms. Conclusions Unprecedented social isolation policies to address COVID-19 were associated with increased intentional injury, especially gun violence. Meanwhile, ED and non-intentional trauma visits decreased. Pandemic-related public health measures should embrace intentional injury prevention and management strategies.