Changes in adult trauma at a level 1 trauma center before and during the COVID-19 pandemic

Prior research has shown the COVID-19 pandemic is associated with changes in ED volumes, trauma caseloads and distribution of disease.

We aim to characterize the impact of the COVID-19 pandemic at a diverse, high-volume Level 1 trauma center in the US.

We performed a retrospective review of our institutional trauma registry at our center from 2018 through 2021 to study changes before and after COVID-19. We established March 14 - December 31 as the study period of interest for each year. We analyzed the data with descriptive statistics and created Poisson regression models to determine the estimated percentage year-to-year changes.

Total number of trauma cases increased with each subsequent year from 2018 (N ​= ​4605) to 2021 (N ​= ​7331) (total N ​= ​23,727). In general, the proportion of Black or African American patients increased over time (2018: 19.2%, 2021: 23.0%). The proportion of patients insured by Medicaid (8.0% vs 10.5%) and Medicare (26.5% vs 32.8%) increased from 2018 to 2021. Comparing 2019 to 2020, we found increases in violent traumas: GSW (+88.6%, 95% CI 63.8%-117.2%) and stabbings (+39.6%, 95% CI 8.1%-80.3%). Trauma patient ED LOS decreased from 300 ​min (67-400 IQR) in 2018 to 249 ​min in 2021 (104-510 IQR).

This analysis identified increased trauma volumes, especially violent trauma (GSW, stabbing, other penetrating). There was a greater proportion of Black/African American patients and those insured with Medicare or Medicaid during the pandemic. TED LOS decreased over time while ED mortality and hospital LOS remained stable.