Trauma volumes and injury types changed significantly for most hospitals during the early months of the COVID-19 pandemic. Most trauma centers saw an overall reduction in trauma cases as a result of work closures and stay-at-home orders. At the same time, some trauma leaders reported increases in domestic, recreational, and pediatric trauma and specific mechanisms of injury.
I recently asked trauma data analysts, trauma program managers and injury prevention specialists at several hospitals about injury patterns during April and May. The data and anecdotal evidence they shared provides a glimpse of how the current pandemic has altered injury trends.
Level I trauma center in Texas: Fewer crashes, more domestic injuries
JPS Health Network (Fort Worth, Texas) saw a general decline in trauma volumes. However, program leaders also detected interesting counter-trends in a few injury types.
Sheryl Cloud, BSN, RN, CSTR, registry manager, shared data comparing the period of March 1 to April 14, 2020, to the same period in 2019. Key takeaways include:
- Motor vehicle crashes, motorcycle crashes and falls all declined by about one-third
- Burn and electric shock injuries, although relatively uncommon, quadrupled
- Assaults without a weapon decreased about one-fourth
- Stab wounds increased about one-fifth
- Machinery and equipment injuries and hospital readmissions were eliminated
Level II trauma center in California: More pediatric MVCs, more risk-taking
Trauma volumes declined at Kaiser Permanente Vacaville Medical Center (Vacaville, California) at the start of the pandemic but began to rise at the end of April.
According to Amy Brammer, MSN, RN, TNS, CEN, CAISS, CSTR, trauma program director, some injury pattern changes can be tied to lockdown conditions.
“I have noticed more injuries during the week that we would not normally see,” Brammer said in early May. “We are seeing more pediatric patients involved in MVCs because they are not attending school and are accompanying their parents on errands. We are also seeing more recreational vehicle injuries sustained by people who would normally be at work.”
Injuries associated with alcohol use also increased during this period. “People appear to be taking risks they wouldn’t usually take,” Brammer said.
As of the second week of June, trauma volumes were still below typical levels but injury severity appeared to be increasing. “We have now noticed an increase in patients requiring immediate surgical intervention,” Brammer said. “Our volume of ‘ED to the OR’ patients is up.”
Level I trauma center in Pennsylvania: Delayed visits for injuries
At Lehigh Valley Hospital Cedar Crest (Allentown, Pennsylvania), trauma volumes were down approximately 30% between mid-March and mid-April.
According to Judith Schultz, BA, CSTR, CAISS, trauma registry manager, the center saw little change in injury type during these weeks. However, there was a small but noticeable increase in injured patients making delayed visits to the hospital — for example, several-day-old burns and several-week-old fractures.
“We believe people may have been understandably trying to avoid the ER because of COVID,” Schultz said.
To help reduce delayed visits, the hospital updated its communications campaign to clarify that people should still come to the emergency department for emergencies.
Academic trauma system in Michigan: Volume down, no change in injury type
Information analysts at the University of Michigan reported lower trauma volumes during the pandemic, but little change in injury type.
At C.S. Mott Children’s Hospital (Ann Arbor, Michigan), there was only a slight decline in the number of trauma cases meeting trauma registry inclusion criteria, according to Jane Riebe-Rodgers, MPH, CSTR, clinical information analyst. “However, there has been a dramatic decline in the overall number of patients presenting to the ED, which was down by 75% to 80%.”
C.S. Mott saw no change in injury type or severity, and non-accidental trauma was almost non-existent. However, there was a big drop in outside transfers.
“We consistently see about 60% transfers in from other facilities,” Riebe-Rodgers said. “That dropped off to 40% in March and just slightly more than 25% in April.”
The system’s adult trauma center experienced a similar pattern, according to Cecilia Roiter, RHIT, CAISS, CSTR, clinical information analyst at the University of Michigan Health System Trauma Burn Center.
“I would have to agree with a total decline in trauma volume,” Roiter said. “I have not seen an increase in any specific injury pattern or mechanism, just an overall decline in all mechanisms.”
Level I pediatric trauma center in the Midwest: Big jump in volume
A large pediatric hospital in the Midwest received more injured children during the early months of the pandemic, according to a member of the program management team.
“Unlike most centers, we saw a 65% to 75% increase in our trauma volumes,” the program leader said. “I would assume this is because more kids were at home, playing, etc. We also saw an uptick in non-accidental trauma patients — anecdotally, I’d ballpark it at about a 30% increase — and also an increase in orthopedic and pedestrian strucks.”
Research on pandemic injury patterns
A handful of trauma researchers have published studies and other reports on injury patterns during COVID-19:
- Impact of shelter-in-place order for COVID-19 on trauma activations (California, USA)
- Vehicle related injury patterns during the COVID-19 pandemic: What has changed? (Florida, New York, Massachusetts, USA)
- Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the “golden month” (UK)
- Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 (New Zealand)
- Decrease in trauma admissions with COVID-19 pandemic (New Hampshire, USA)
- Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department (South Africa)
- Letter: The early effects of social distancing resultant from COVID-19 on admissions to a Level I trauma center (Kentucky, USA)
- Blog post: COVID-19’s impact on injury: Preliminary patterns across Texas (Texas, USA)
Injury trends in the news
Several general media outlets reported on changes in injury patterns during the coronavirus pandemic:
- Washington Post (United States): More severe cases of child abuse
- CBS News (United States): Large increase in fatal unintentional shootings by children
- Daily Examiner (Australia): Small increase in domestic injuries
- Sunday Times (South Africa): Alcohol ban cuts violent death rate in half
- Kaiser Health News (United States): Mixed reports from around the U.S.
Robert Fojut is the editor of Trauma System News.