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Coronavirus Disease 2019 and the Injured Patient: A Multicenter Review
Hazim Hakmi1, Shahidul Islam2, Patrizio Petrone1
1Department of Surgery, NYU Langone Hospital-Long Island, Mineola, New York; NYU Long Island School of Medicine, Mineola, New York.
Insights
COVID-19 significantly increased mortality and length of stay for trauma patients, even with lower injury severity scores (ISS). This highlights the severe impact of coronavirus disease 2019 on trauma care outcomes.
Area of Science:
- Trauma Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) impacts surgical patient outcomes.
- The effect of COVID-19 on trauma patient mortality and length of stay requires investigation.
Purpose of the Study:
- To determine if COVID-19 is associated with increased mortality and longer hospital stays in trauma patients.
- To compare outcomes between COVID-19 positive (COVID+) and COVID-19 negative (COVID-) trauma patients.
Main Methods:
- Retrospective analysis of trauma registries from two level 1 trauma centers.
- Comparison of patient cohorts from March-June 2019 and March-June 2020 (during the first New York COVID-19 wave).
- Kaplan-Meier and Cox proportional hazard models used to analyze mortality and length of stay.
Main Results:
- COVID+ trauma patients (n=148) had higher mortality and longer length of stay compared to COVID- patients (n=436).
- COVID+ patients presented with lower injury severity scores (ISS) but more comorbidities and adverse events.
- C-reactive protein levels were higher in COVID+ patients; D-dimer and ferritin were unreliable indicators of severity.
Conclusions:
- COVID-19 is linked to increased morbidity and mortality in trauma patients, irrespective of injury severity.
- C-reactive protein may serve as a monitoring marker for COVID-19 in trauma patients.
- Further research is needed to understand the physiological impact of COVID-19 on injured patients.
Introduction:
Coronavirus disease 2019 (COVID-19) has been shown to affect outcomes among surgical patients. We hypothesized that COVID-19 would be linked to higher mortality and longer length of stay of trauma patients regardless of the injury severity score (ISS).
Methods:
We performed a retrospective analysis of trauma registries from two level 1 trauma centers (suburban and urban) from March 1, 2019, to June 30, 2019, and March 1, 2020, to June 30, 2020, comparing baseline characteristics and cumulative adverse events. Data collected included ISS, demographics, and comorbidities. The primary outcome was time from hospitalization to in-hospital death. Outcomes during the height of the first New York COVID-19 wave were also compared with the same time frame in the prior year. Kaplan-Meier method with log-rank test and Cox proportional hazard models were used to compare outcomes.
Results:
There were 1180 trauma patients admitted during the study period from March 2020 to June 2020. Of these, 596 were never tested for COVID-19 and were excluded from the analysis. A total of 148 COVID+ patients and 436 COVID- patients composed the 2020 cohort for analysis. Compared with the 2019 cohort, the 2020 cohort was older with more associated comorbidities, more adverse events, but lower ISS. Higher rates of historical hypertension, diabetes, neurologic events, and coagulopathy were found among COVID+ patients compared with COVID- patients. D-dimer and ferritin were unreliable indicators of COVID-19 severity; however, C-reactive protein levels were higher in COVID+ relative to COVID- patients. Patients who were COVID+ had a lower median ISS compared with COVID- patients, and COVID+ patients had higher rates of mortality and longer length of stay.
Conclusions:
COVID+ trauma patients admitted to our two level 1 trauma centers had increased morbidity and mortality compared with admitted COVID- trauma patients despite age and lower ISS. C-reactive protein may play a role in monitoring COVID-19 activity in trauma patients. A better understanding of the physiological impact of COVID-19 on injured patients warrants further investigation.
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