6 Its recommendations were directed toward resource allocation, preserving capacity, and ensuring adequate protection of trauma team members. The American College of Surgeons Committee on Trauma (ACS-COT) aptly put forth a guide on maintaining trauma center access and care during the pandemic. The surge in patients with COVID-19 to emergency departments (ED), with many subsequently requiring admission to intensive care units (ICUs), forced many trauma centers to modify their existing protocols. While the pandemic has affected all facets of life, the nation’s health care infrastructure has been tested unlike during any event in recent history. 3, 4 Despite these aggressive measures, by late July California had the highest number of cumulative cases, with LAC serving as the epicenter of the nation. California became the first state to implement a stay-at-home mandate by way of executive order on March 19, 2020. 1, 2 In an effort to curb viral spread, local and state authorities across many areas of the country enforced social distancing guidelines with the closure of all nonessential businesses. On January 20, 2020, the US Centers for Disease Control and Prevention reported the first confirmed case of coronavirus disease 2019 (COVID-19) in Washington state, and on January 26, 2020, public health officials confirmed the first case in Los Angeles County (LAC). Trauma centers should prioritize maintaining access, capacity, and functionality during pandemics and other national emergencies. A transient decrease in volume was followed by a quick return to baseline levels. On subgroup analysis, blunt admissions followed a similar pattern to overall admissions, while penetrating admissions increased throughout the study period.Ĭonclusions and Relevance In this study, trauma centers throughout LAC experienced a significant change in injury patterns and admission trends during the COVID-19 pandemic. There was a significant increase in overall admissions per week during the first interval (incidence rate ratio, 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). Overall admissions by interval in 2020 were 2681, 1684, and 2412, whereas in 2019 they were 2462, 1862, and 2613, respectively. 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 vs 1065 blunt: 5309 vs 5528 ). Of those admitted in 2020, the median (interquartile range) age was 42 (28-61) years and 5100 (75.3%) were men. Results A total of 6777 patients in 20 in 2019 met inclusion criteria. Main Outcomes and Measures Trends in trauma admission volume and injury patterns. 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). 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). All trauma admissions from the same period in 2019 were used as historical control. Objective To examine trends in trauma admissions throughout Los Angeles County (LAC) during the pandemic.ĭesign, 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 Jwere reviewed. 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. Shared Decision Making and Communication.
Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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