Response to "Changes in traumatic mechanisms of injury in Southern California related to COVID-19: Penetrating trauma as a second pandemic".

To the Editor:

We would like to thank Yeates et al.[1] for their timely and valuable publication on changes in traumatic injury patterns in Southern California during the recent pandemic. A similar trend occurred in Texas, where, similar to California, orders to limit social gatherings and visitation of nonessential public locations to mitigate transmission of severe acute respiratory syndrome coronavirus 2 went into effect by Governor’s decree on March 19, 2020.[2] However, by the end of June in Texas, stores, restaurants, and other essential services were permitted to reopen to 50% of total occupancy.[3] As of March 2021, Texas has been reopened to full capacity.[4] Despite the variation in duration of restrictions, a similar variation of injury pattern was noted in the West Texas region.

Our level 1 trauma center provides care for the urban region of Lubbock County, as well as the surrounding rural areas of West Texas and Eastern New Mexico. As the only level 1 center in the region, we are the primary referral source for severe injuries. We evaluated rates of overall trauma, blunt trauma, accidental trauma, assaultive trauma, and self-inflicted trauma in this region during the pandemic and compared these with historic patterns from 2015 to 2019.

Despite overall injury severity scores remaining unchanged in 2020 (χ2 [5] = 6.16, p = 0.29, Kruskal-Wallis H test), we discovered a significant increase in all-cause penetrating trauma compared with all-cause blunt trauma: 374 of 2,448 cases (15.28%) in 2020 compared with 1,108 of 12,101 from 2015 to 2019 (p < 0.001, Fisher’s exact test). In addition, over this same period, we found an increase in assaultive penetrating trauma in the urban environment of Lubbock County compared with the surrounding rural communities in 2020: 95 of 175 cases (54.29%) in 2020 compared with 218 of 532 from 2015 to 2019 (p = 0.0028, Fisher’s exact test). Conversely, we found an increase in accidental penetrating trauma within the surrounding rural communities: 100 of 165 cases (60.61%) in 2020 compared with 327 of 453 from 2015 to 2019 (p = 0.0078, Fisher’s exact test).

Similar to the findings of Yeates et al.,[1] we found an increased rate of penetrating trauma in 2020, particularly, a significant increase in assaultive penetrating trauma in Lubbock County, relative to the surrounding rural communities. These data suggest that factors unique to the year 2020 may have affected urban communities disproportionately to rural communities. It is possible that regulations around social distancing created a greater negative impact on mental health, social well-being, and cohesion in urban versus rural communities; it is also possible that financial constraints had a different impact in different regions. Variations in injury patterns in 2020 have anecdotally been shared by many trauma centers across the country; compiling these patterns into a snapshot of the pandemic impact may help inform future decisions regarding trauma prevention during a public health crisis.