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The impact of COVID-19 infection on outcomes after injury in a state trauma system
Elinore J Kaufman1, Adrian W Ong, Mark D Cipolle
1From the Division of Traumatology, Surgical Critical Care, and Emergency Surgery (E.J.K.), University of Pennsylvania, Philadelphia; Department of Surgery (A.W.O.), Reading Hospital and Medical Center, Reading; Division of Trauma and Acute Care Surgery (M.D.C.), Lehigh Valley Health Network, Allentown; Department of Surgery (G.W.), University of Pennsylvania, Philadelphia; Department of Surgery (A.R.), Crozer-Chester Medical Center Upland; Department of Research & Innovation (S.P.S.), St. Luke's University Health Network, Bethlehem; and Division of Traumatology, Surgical Critical Care, and Emergency Surgery (N.D.M.), University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
The COVID-19 pandemic reshaped the health care system in 2020. COVID-19 infection has been associated with poor outcomes after orthopedic surgery and elective, general surgery, but the impact of COVID-19 on outcomes after trauma is unknown.
Methods:
We conducted a retrospective cohort study of patients admitted to Pennsylvania trauma centers from March 21 to July 31, 2020. The exposure of interest was COVID-19 (COV+) and the primary outcome was inpatient mortality. Secondary outcomes were length of stay and complications. We compared demographic and injury characteristics between positive, negative, and not-tested patients. We used multivariable regression with coarsened exact matching to estimate the impact of COV+ on outcomes.
Results:
Of 15,550 included patients, 8,170 (52.5%) were tested for COVID-19 and 219 (2.7%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in terms of age and sex, but were less often white (53.5% vs. 74.7%, p < 0.0001), and more often uninsured (10.1 vs. 5.6%, p = 0.002). Injury severity was similar, but firearm injuries accounted for 11.9% of COV+ patients versus 5.1% of COV- patients (p < 0.001). Unadjusted mortality for COV+ was double that of COV- patients (9.1% vs. 4.7%, p < 0.0001) and length of stay was longer (median, 5 vs. 4 days; p < 0.001). Using coarsened exact matching, COV+ patients had an increased risk of death (odds ratio [OR], 6.05; 95% confidence interval [CI], 2.29-15.99), any complication (OR, 1.85; 95% CI, 1.08-3.16), and pulmonary complications (OR, 5.79; 95% CI, 2.02-16.54) compared with COV- patients.
Conclusion:
Patients with concomitant traumatic injury and COVID-19 infection have elevated risks of morbidity and mortality. Trauma centers must incorporate an understanding of these risks into patient and family counseling and resource allocation during this pandemic.
Level Of Evidence:
Level II, Prognostic Study.
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