Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California.
Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California.
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DOI：
10.1001/jamanetworkopen.2021.1320
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Inaba K
中科院分区：
文献类型：
--
作者：
Ghafil C;Matsushima K;Ding L;Henry R;Inaba K
在2019年冠状病毒病大流行期间，大都市地区的创伤入院量和受伤模式发生了怎样的变化？在这项对2020年1月1日至6月7日洛杉矶县6777例创伤住院患者进行的回顾性队列研究中，总体数量短暂下降，但很快恢复到基线水平。损伤的机制有很大的不同，穿透伤的入院率稳步上升。这些调查结果突出表明，尽管公共活动受到广泛限制，但社区的创伤负担仍然存在，在国家紧急情况期间需要维持创伤护理资源和减少暴力的努力。这项队列研究考察了2019年冠状病毒病（COVID-19）大流行期间加州洛杉矶县创伤入院的趋势。描述2019冠状病毒病（COVID-19）大流行期间创伤量和损伤模式的变化有助于为政策制定和医院资源规划提供信息。研究大流行期间整个洛杉矶县（LAC）的创伤入院趋势。在这项队列研究中，审查了2020年1月1日至6月7日期间LAC 15个经过验证的1级和2级创伤中心的所有创伤入院情况。2019年同期的所有创伤入院病例均用作历史对照。对于总体入院情况，研究期间根据每日入院趋势分析分为3个时间段（1月1日至2月28日，3月1日至4月9日，4月10日至6月7日）。对于钝性创伤亚组分析，研究期间分为3个相似的时间间隔（1月1日至2月27日，2月28日至4月5日，4月6日至6月7日）。2019冠状病毒病大流行。创伤入院量和损伤模式的趋势。2020年共有6777例患者符合入选标准，2019年共有6937例患者符合入选标准。在2020年入院的患者中，中位（四分位数范围）年龄为42（28-61）岁，男性5100人（75.3%）。两年间的损伤机制存在显著差异，与2019年相比，2020年穿透性创伤的发生率较高，钝性损伤较少（穿透性：1065 [15.7%] vs 1065 [15.4%];钝性：5309 [78.3%] vs 5528 [79.7%]）。2020年按时间间隔划分的总入院人数分别为2681人、1684人和2412人，而2019年分别为2462人、1862人和2613人。在第一个间隔期间，每周的总入院人数有显著增加（发生率比[IRR]，1.02; 95% CI，1.002-1.04; P = 0.03），随后在第二个间期降低（IRR，0.92; 95% CI，0.90-0.94; P <0.001），最后，第三个间期增加（IRR，1.05; CI，1.03-1.07; P <0.001）。在亚组分析中，钝性入院遵循与总体入院相似的模式，而穿透性入院在整个研究期间增加。在这项研究中，整个LAC的创伤中心在COVID-19大流行期间经历了损伤模式和入院趋势的显著变化。容量短暂下降后迅速恢复至基线水平。创伤中心应优先考虑在流行病和其他国家紧急情况下保持访问，容量和功能。
How have trauma admission volume and injury patterns changed in metropolitan areas during the coronavirus disease 2019 pandemic? 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. 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. This cohort study examines trends in trauma admissions throughout Los Angeles County, California, during the coronavirus disease 2019 (COVID-19) pandemic. 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. To examine trends in trauma admissions throughout Los Angeles County (LAC) during the pandemic. 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). COVID-19 pandemic. Trends in trauma admission volume and injury patterns. 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. 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.
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