Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California | Emergency Medicine | JAMA Network Open | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Holshue  ML, DeBolt  C, Lindquist  S,  et al; Washington State 2019-nCoV Case Investigation Team.  First case of 2019 novel coronavirus in the United States.   N Engl J Med. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191PubMedGoogle ScholarCrossref
County of Los Angeles Public Health. Public Health confirms first case of 2019 novel coronavirus in Los Angeles County. Updated January 2, 2021. Accessed January 2, 2021.
Executive Department: State of California. Executive Order N-33-20. Updated March 19, 2020. Accessed October 20, 2020.
Johns Hopkins University and Medicine Coronavirus Resource Center. COVID-19 United States cases by county. Updated October 7, 2020. Accessed October 15, 2020.
Johns Hopkins University and Medicine Coronavirus Resource Center. Impact of opening and closing decisions by states. Updated August 1, 2020. Accessed November 11, 2020.
American College of Surgeons. Maintaining trauma center access and care during the COVID-19 pandemic: guidance document for trauma medical directors. Updated March 20, 2020. Accessed October 20, 2020.
Christey  G, Amey  J, Campbell  A, Smith  A.  Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand.   N Z Med J. 2020;133(1513):81-88.PubMedGoogle Scholar
Forrester  JD, Liou  R, Knowlton  LM, Jou  RM, Spain  DA.  Impact of shelter-in-place order for COVID-19 on trauma activations: Santa Clara County, California, March 2020.   Trauma Surg Acute Care Open. 2020;5(1):e000505. doi:10.1136/tsaco-2020-000505PubMedGoogle Scholar
Leichtle  SW, Rodas  EB, Procter  L, Bennett  J, Schrader  R, Aboutanos  MB.  The influence of a statewide “stay-at-home” order on trauma volume and patterns at a level 1 trauma center in the United States.   Injury. 2020;51(11):2437-2441. doi:10.1016/j.injury.2020.08.014PubMedGoogle ScholarCrossref
Qasim  Z, Sjoholm  LO, Volgraf  J,  et al.  Trauma center activity and surge response during the early phase of the COVID-19 pandemic—the Philadelphia story.   J Trauma Acute Care Surg. 2020;89(4):821-828. doi:10.1097/TA.0000000000002859PubMedGoogle Scholar
Hatchimonji  JS, Swendiman  RA, Seamon  MJ, Nance  ML.  Trauma does not quarantine: violence during the COVID-19 pandemic.   Ann Surg. 2020;272(2):e53-e54. doi:10.1097/SLA.0000000000003996PubMedGoogle ScholarCrossref
Jacob  S, Mwagiru  D, Thakur  I, Moghadam  A, Oh  T, Hsu  J.  Impact of societal restrictions and lockdown on trauma admissions during the COVID-19 pandemic: a single-centre cross-sectional observational study.   ANZ J Surg. 2020;90(11):2227-2231. doi:10.1111/ans.16307PubMedGoogle ScholarCrossref
von Elm  E, Altman  DG, Egger  M, Pocock  SJ, Gøtzsche  PC, Vandenbroucke  JP; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.   Int J Surg. 2014;12(12):1495-1499. doi:10.1016/j.ijsu.2014.07.013PubMedGoogle ScholarCrossref
Department of Health Services, County of Los Angeles. Data management division. Accessed November 11, 2020.
Department of Health Services, County of Los Angeles. Trauma Center Data Dictionary. Accessed November 11, 2020.
Webb Hooper  M, Nápoles  AM, Pérez-Stable  EJ.  COVID-19 and racial/ethnic disparities.   JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598PubMedGoogle ScholarCrossref
Tung  EL, Hampton  DA, Kolak  M, Rogers  SO, Yang  JP, Peek  ME.  Race/ethnicity and geographic access to urban trauma care.   JAMA Netw Open. 2019;2(3):e190138-e190138. doi:10.1001/jamanetworkopen.2019.0138PubMedGoogle ScholarCrossref
Unite Against COVID-19. New Zealand COVID-19 alert levels summary. Updated August 20, 2020. Accessed October 17, 2020.
Shilling  F, Waetjen  D. Special report (update): impact of COVID-19 mitigation on numbers and costs of California traffic crashes. Updated April 4, 2020. Accessed October 8, 2020.
Bolkan  HA, van Duinen  A, Samai  M,  et al.  Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak.   BMC Health Serv Res. 2018;18(1):846-846. doi:10.1186/s12913-018-3666-9PubMedGoogle ScholarCrossref
Schull  MJ, Stukel  TA, Vermeulen  MJ,  et al.  Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome.   CMAJ. 2007;176(13):1827-1832. doi:10.1503/cmaj.061174PubMedGoogle ScholarCrossref
Office of Governor Gavin Newsom. Governor Newsom provides update on California’s progress toward stage 2 reopening. Updated May 04, 2020. Accessed November 11, 2020.
US Federal Bureau of Investigation. NICS firearm checks: month/year. Accessed October 8, 2020.
US Federal Bureau of Investigation. NICS firearm checks: month/year by state/type. Accessed October 8, 2020.
Cambell  J. US firearms purchases skyrocket during pandemic, according to FBI records. Updated August 3, 2020. Accessed October 8, 2020.
Zarzaur  BL, Stahl  CC, Greenberg  JA, Savage  SA, Minter  RM.  Blueprint for restructuring a department of surgery in concert with the health care system during a pandemic: the University of Wisconsin experience.   JAMA Surg. 2020;155(7):628-635. doi:10.1001/jamasurg.2020.1386PubMedGoogle ScholarCrossref
Nassar  AH, Zern  NK, McIntyre  LK,  et al.  Emergency restructuring of a general surgery residency program during the coronavirus disease 2019 pandemic: the University of Washington experience.   JAMA Surg. 2020;155(7):624-627. doi:10.1001/jamasurg.2020.1219PubMedGoogle ScholarCrossref
Juprasert  JM, Gray  KD, Moore  MD,  et al.  Restructuring of a general surgery residency program in an epicenter of the coronavirus disease 2019 pandemic: lessons from New York City.   JAMA Surg. 2020;155(9):870-875. doi:10.1001/jamasurg.2020.3107PubMedGoogle ScholarCrossref
Kibbe  MR.  Surgery and COVID-19.   JAMA. 2020;324(12):1151-1152. doi:10.1001/jama.2020.15191PubMedGoogle ScholarCrossref
Fransvea  P, Sganga  G, Cozza  V,  et al.  Set up of a dedicated COVID-19 surgical pathway and operating room for surgical emergencies.   J Trauma Acute Care Surg. 2020;89(4):e97-e100. doi:10.1097/TA.0000000000002852PubMedGoogle Scholar
Coons  BE, Tam  SF, Okochi  S.  Rapid development of resident-led procedural response teams to support patient care during the coronavirus disease 2019 epidemic: a surgical workforce activation team.   JAMA Surg. 2020;155(8):683-684. doi:10.1001/jamasurg.2020.1782PubMedGoogle ScholarCrossref
Cal Fire. Accessed January 2, 2021.
California Nevada River Forecast Center. Observed precipitation. Updated January 2, 2021. Accessed January 2, 2021.
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 34,306
    Citations 0
    Original Investigation
    February 22, 2021

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

    Author Affiliations
    • 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
    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.


    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.