Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California | Emergency Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Surgery
    February 22, 2021

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

    Cameron Ghafil, MD1; Kazuhide Matsushima, MD1; Li Ding, MD, MPH2; et al Reynold Henry, MD, MPH1; Kenji Inaba, MD1
    Author Affiliations Article Information
    • 1Division of Acute Care Surgery, University of Southern California, Los Angeles
    • 2Department of Preventive Medicine, University of Southern California, Los Angeles
    JAMA Netw Open. 2021;4(2):e211320. doi:10.1001/jamanetworkopen.2021.1320
    COVID-19 Resource Center
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    Key Points

    Question  How have trauma admission volume and injury patterns changed in metropolitan areas during the coronavirus disease 2019 pandemic?

    Findings  In this retrospective cohort study of 6777 trauma admissions in Los Angeles County from January 1 to June 7, 2020, overall volume transiently decreased but quickly returned to baseline. Mechanisms of injury were significantly different, with a steady increase in admissions for penetrating injuries.

    Meaning  These findings highlight the persistence of trauma burden in the community despite widespread restriction on public activity and the need to maintain trauma care resources and violence mitigation efforts during national emergencies.

    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.

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