The early effects of social distancing resultant from COVID-19 on admissions to a Level I trauma center.

Trauma imposes a major burden on the healthcare system. The US has a well-developed public health program and trauma systems. Despite that, trauma is still responsible for a sizable number of hospital admissions. Besides, it's a prominent cause of death of young adults. Multiple elements dictate the number and pattern of trauma admission to the emergency department (ED), such as location, population density and size, economy, weather, social factors, and others. These factors can be unique to each region; therefore, it can lead to different patterns. Major disasters can strain the healthcare system through altering the volume and pattern of trauma admissions. Therefore, it is crucial to have a standard protocol to address the response to a disaster effectively. The recent COVID-19 pandemic was unique as it affected the entire globe and posed a challenge to all healthcare systems. For hospitals, it was a unique challenge since there wasn't a clear view as to the potential extent, duration, and effects of this pandemic on resource utilization and healthcare personnel allocation. In response to the pandemic, both the federal and state governments in the US implemented the social distancing measures to slow the spread of infection. Our institution is a level I trauma center in the city of Louisville, in the northern part of Kentucky. The population of the city is about 620,000, while the state is about 4.5 million. The state government started the social distancing measures in Kentucky in mid-March 2020 and it included closure of universities, schools, and non-essential businesses (restaurants, bars, music venues, and others). Since the COVID-19 pandemic and the ensuing changes affected multiple facets of our lives, we sought to identify its effect on the volume and pattern of trauma admissions to our ED. Our goal was to identify changes that might help to establish protocols that will enhance the hospital readiness in an analogous situation.  We reviewed the cases that were admitted to our hospital ED from January through mid-April for both 2019 and 2020. Also, we reviewed the weather data which were similar for both years.

Both periods had a comparable number of cases and population demographics (average age and gender distribution). Also, the admis admissions time of the day was not different which was interesting as we thought there will be fewer admissions in the late evening and overnight because of closure of restaurants, bars, and other entertainment venues. The mechanism of injury proportions were comparable as well with falls being the most common followed by motor vehicle collision. The data from mid-March to mid-April showed a difference in the mechanism of injury patterns between 2019 and 2020. There were fewer falls with more gunshot wounds and burns in 2020. This difference can be coincidental but also can be explained by the social distancing.

One can hypothesize that when people spend more time at home, it might increase the burn injuries as a result of increased cooking or barbecuing. Concerning the increased gunshot wound injuries, both the accidental and assault type GSW can also increase under these circumstances (i.e. social distancing). The it increased unemployment rate and significant decline in income can trigger an increase in criminal behaviors. A Also, as people spend more time at home, there is more chance for increased weapons handling (e.g. cleaning). As for the falls, there were more stringent social distancing recommendations for the elderly because of the increased risk of this age group to contract the infection with the potential for devastating outcomes. This age group also at increased risk for falls, therefore, when they spend less time outside their risk for falling declines.

Finally, although several factors affect the trauma admissions to an emergency department, but the overall pattern is stable. Exceptional circumstances like the COVID-19 can alter these patterns which should be considered as it can affect the preparation and resource allocation for trauma centers.

Funding source

None

Declarations of Competing Interests

None