Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California

Abstract

Importance: Describing the changes in trauma volume and injury patterns during the course of the coronavirus disease 2019 (COVID-19) pandemic could help to inform policy development and hospital resource planning.

Objective: To examine trends in trauma admissions throughout Los Angeles County (LAC) during the pandemic.

Design, setting, and participants: In this cohort study, all trauma admissions to the 15 verified level 1 and level 2 trauma centers in LAC from January 1 to June 7, 2020 were reviewed. All trauma admissions from the same period in 2019 were used as historical control. For overall admissions, the study period was divided into 3 intervals based on daily admission trend analysis (January 1 through February 28, March 1 through April 9, April 10 through June 7). For the blunt trauma subgroup analysis, the study period was divided into 3 similar intervals (January 1 through February 27, February 28 through April 5, April 6 through June 7).

Exposures: COVID-19 pandemic.

Main outcomes and measures: Trends in trauma admission volume and injury patterns.

Results: A total of 6777 patients in 2020 and 6937 in 2019 met inclusion criteria. Of those admitted in 2020, the median (interquartile range) age was 42 (28-61) years and 5100 (75.3%) were men. Mechanisms of injury were significantly different between the 2 years, with a higher incidence of penetrating trauma and fewer blunt injuries in 2020 compared with 2019 (penetrating: 1065 [15.7%] vs 1065 [15.4%]; blunt: 5309 [78.3%] vs 5528 [79.7%]). Overall admissions by interval in 2020 were 2681, 1684, and 2412, whereas in 2019 they were 2462, 1862, and 2613, respectively. There was a significant increase in overall admissions per week during the first interval (incidence rate ratio [IRR], 1.02; 95% CI, 1.002-1.04; P = .03) followed by a decrease in the second interval (IRR, 0.92; 95% CI, 0.90-0.94; P < .001) and, finally, an increase in the third interval (IRR, 1.05; CI, 1.03-1.07; P < .001). On subgroup analysis, blunt admissions followed a similar pattern to overall admissions, while penetrating admissions increased throughout the study period.

Conclusions and relevance: In this study, trauma centers throughout LAC experienced a significant change in injury patterns and admission trends during the COVID-19 pandemic. A transient decrease in volume was followed by a quick return to baseline levels. Trauma centers should prioritize maintaining access, capacity, and functionality during pandemics and other national emergencies.

Figure 1.. Trauma Admission Trends by Year

Scatter plots with individual points representing daily countywide totals. Orange vertical lines represent implementation of a stay-at-home order (March 18) and the announcement of stage 2 of reopening (May 7). Blue vertical lines in panels A and B, which divide study period into 3 intervals, represent knot positions based on trend analysis.

Figure 2.. Kaplan-Meier Survival Curve Comparing 30-Day Mortality by Year

Survival curve with 95% Hall-Wellner confidence bands for 30-day mortality stratified by year. Crosses indicate censored data, and shaded areas indicate 95% confidence bands.