BACKGROUND: The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease . Very little is known about the impact of these restrictions on trauma centers . Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient's demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital .
METHODS: An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15 , 2020 - June 15 , 2020) with a control period (same period in 2017-2019). Comparisons were done using the Pearson's chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate . A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods . Statistical significance was set at p <0.05 .
RESULTS: A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020 . The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p <0.001) for the lockdown period compared to the historical period . Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury . Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7% ; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8% ; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups . Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31-0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS .
CONCLUSIONS: Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns . Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.
Index: COVID-19, Injury patterns, Lockdown, Pandemic, Trauma