Changes in injury presentations during the COVID-19 pandemic in the USA: results from the National Electronic Injury Surveillance System

Lyle Ellerbee

Lifestyle alterations for the duration of the COVID-19 pandemic have been demonstrated to be linked with a transform in trauma designs with regard to motor car collisions, assaults and suicide tries.1–3 We investigated modifications in ED visits in the United states of america for accidents related to customer solutions before and through the COVID-19 pandemic.

The National Digital Harm Surveillance Procedure databases collects information and facts on non-violent/non-motor motor vehicle-related trauma from close to 100 EDs across the Usa, letting nationwide estimates of injuries. We received 2019 and 2020 data and employed the key situations to divide the pandemic into 3 intervals: very first interval beginning 20 January 2020, when Facilities for Condition Handle and Avoidance verified the to start with COVID-19 situation in the United states of america till 12 March 2020 next interval starting off 13 March 2020, when a national condition of unexpected emergency was declared and lockdowns began till 19 April 2020 third interval starting off 20 April 2020, when Texas grew to become the to start with state to start a phased reopening of economic climate until finally the close of 2020. We used t-test and Pearson’s χ2 test to determine the differences among the pandemic and comparable time frames through 2019. Two-sided p values <0.05 were considered significant. We obtained institutional review board exempt status.

There was no significant decrease for non-violent, non-motor vehicle trauma presentations between 2019 and the period between the first case and lockdown (20 January to 12 March 2020) (33 815 vs 33 296, Δ−1.53%, p=0.27) (figure 1). However, compared with 2019, there was a significant drop in average daily ED visits both during the lockdown period of 13 March to 19 April 2020 (36 658 vs 20 685, Δ−43.6%, p<0.001) and as lockdowns lifted between 20 April and 31 December 2020 (37 939 vs 30 356, Δ−20%, p<0.001). The mean age (46.6 vs 51.5 years, p<0.001) and percentage of patients who were men (52.2% vs 54%, p=0.02) increased from the control period to the lockdown period (table 1). There was a significant decrease in these trauma presentations in all age groups, with the largest decrease in school-age children (figure 1).

Figure 1
Figure 1

Daily emergency visits for trauma in 2019 and 2020 defined by the age groups.

Table 1

Comparison of patient/injury characteristics between the lockdown and control period (from 13 March to 19 April)

The injured body part, type, location and disposition of injuries during the lockdown period were significantly different from the control period (p<0.001 table 1). Notably, lacerations and fractures increased proportionally while other injury types declined or stayed the same. During the lockdown, proportionally more patients were hospitalised and died in ED compared with the control period in 2019 (table 1). Injuries associated with saws, lawn mowers, all-terrain vehicles, house repair/construction materials and power drills increased while injuries associated with stairs/steps, sports and floors/flooring material decreased (online supplemental table 1).

Similar to previous studies of ED visits, we observed a prominent decline in mean daily ED visits for trauma related to consumer products during the lockdown.2 4 5 This trend is likely due to a combination of less public interaction (eg, sports) and reluctance to seek ED care during a pandemic. The decrease in public and sports-related trauma presentations and simultaneous proportional increase in domestic injuries reflect the shift of activities undertaken during lockdown. Interestingly, despite more time spent at home, there was a drop in the number of ED visits for trauma sustained at home (eg, beds/bedframes) which could be explained by the fact that patients refrain from going to hospitals due to a fear of COVID-19. Indeed, injuries sustained during the pandemic were significantly more severe as resulting in higher rates of admission and death.

In conclusion, we found that the COVID-19 lockdown period has been associated with a change in trauma presentations. The contributing factors could be investigated further to prevent such injuries during reopening and return to post-COVID normalcy.

Data availability statement

Data are available upon reasonable request.

Ethics statements

Patient consent for publication

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