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. 2021 Feb;232(2):159-168.e3.
doi: 10.1016/j.jamcollsurg.2020.09.028. Epub 2020 Nov 6.

Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden

Hatem O Abdallah  1 , Cindy Zhao  1 , Elinore Kaufman  2 , Justin Hatchimonji  2 , Robert A Swendiman  2 , Lewis J Kaplan  3 , Mark Seamon  3 , C William Schwab  3 , Jose L Pascual  4
Affiliations

Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden

Hatem O Abdallah et al. J Am Coll Surg. 2021 Feb.

Abstract

Background: Public health measures were instituted to reduce COVID-19 spread. A decrease in total emergency department 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, driven primarily by an increase in penetrating trauma.

Study design: A retrospective review of acute adult patient care in an urban Level I trauma center assessed injury patterns. Presenting patient characteristics and diagnoses from 6 weeks pre to 10 weeks post statewide stay-at-home orders (March 16, 2020) were compared, as well as with 2015-2019. Subsets were defined by intentionality (intentional vs nonintentional) and mechanism of injury (blunt vs penetrating). Fisher exact and Wilcoxon tests were used to compare proportions and means.

Results: There were 357 trauma patients that presented pre stay-at-home order and 480 that presented post stay-at-home order. Pre and post groups demonstrated differences in sex (35.6% vs 27.9% female; p = 0.02), age (47.4 ± 22.1 years vs 42 ± 20.3 years; p = 0.009), and race (1.4% vs 2.3% Asian; 63.3% vs 68.3% Black; 30.5% vs 22.3% White; and 4.8% vs 7.1% other; p = 0.03). Post stay-at-home order mechanism of injury revealed more intentional injury (p = 0.0008). Decreases in nonintentional trauma after adoption of social isolation paralleled declines in daily emergency department visits. Compared with earlier years, 2020 demonstrated a significantly greater proportion of intentional violent injury during the peripandemic months, especially from firearms.

Conclusions: Unprecedented social isolation policies to address COVID-19 were associated with increased intentional injury, especially gun violence. Meanwhile, emergency department and nonintentional trauma visits decreased. Pandemic-related public health measures should embrace intentional injury prevention and management strategies.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Comparison of 2020 types of trauma. (A) Intentional vs nonintentional trauma (2020). (B) Blunt vs penetrating cases (2020).
Figure 2
Figure 2
Comparison of 2020 trauma and emergency department (ED) visits. (A) ED vs all trauma contacts (2020). (B) ED vs trauma contacts (2020).
Figure 3
Figure 3
Comparison of data from 2015 to 2020. (A) Trauma cases by year. (B) Percent intentional trauma by year. (C) Percent gunshot wounds by year.
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