Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma

Abstract

Introduction: The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic.

Methods: Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review.

Results: Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States.

Conclusions: A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.

Keywords: COVID-19; Systematic review; Trauma; Violence.

Fig. 1

Process of Article Selection for Inclusion Note: The present protocol was used to search for relevant articles to include in this systematic review.

Fig. 2

Of 44 total records included in this systematic review, 28 included a statistical assessment of changes in violent trauma before and during the COVID-19 pandemic. Of these, 12 studies noted a statistically significant change. Studies examining these data by proportion of all trauma (n = 11) are shown here. Not shown: Morris and colleagues demonstrated a statistically significant decrease (p < 0.05) in rate of assault and gunshot wounds before (2018 and 2019) versus during (2020) the COVID-19 pandemic (Assault: 2018: n = 397, 2019: n = 426, 2020: n = 197; GSW: 2018: n = 32, 2019: n = 20, 2020: n = 3). All other relevant studies used proportion data and are shown in the graphs. Direction of change is shown with the arrows (2A: increasing proportion, right-capped arrow to signify the percentage of violent trauma in 2020; 2B: decreasing proportion, left-capped arrow).

Fig. 3

Study locations and outcomes. Green reflects studies observing increased incidence of violent trauma; red reflects studies showing a decrease. Black indicate studies that found no statistically significant change. Gray indicates studies that reported violent trauma, but did not statistically assess these data before and during the COVID-19 pandemic. Not pictured: five studies were multi-center, and thus not included on this map. These are (with the assigned color as would be pictured on this map): (1) de Boutray and colleagues, multiple sites in France (gray); (2) Benazzo and colleagues, 15 unspecified level one trauma centers in Italy (gray); (3) Walker and colleagues, multiple sites in the United States (black); (4) MacDonald and colleagues, multiple sites in Scotland; and (5) Salzano and colleagues, multiple sites in Italy (red).