Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Am Coll Surg. 2021 Feb;232(2):159-168.e3. doi: 10.1016/j.jamcollsurg.2020.09.028. Epub 2020 Nov 6.
Public health measures were instituted to reduce COVID-19 spread. A decrease in total emergency department volume followed, but the impact on injury is unknown. With lockdown and social distancing potentially increasing domicile discord, we hypothesized that intentional injury increased during COVID-19, driven primarily by an increase in penetrating trauma.
A retrospective review of acute adult patient care in an urban Level I trauma center assessed injury patterns. Presenting patient characteristics and diagnoses from 6 weeks pre to 10 weeks post statewide stay-at-home orders (March 16, 2020) were compared, as well as with 2015-2019. Subsets were defined by intentionality (intentional vs nonintentional) and mechanism of injury (blunt vs penetrating). Fisher exact and Wilcoxon tests were used to compare proportions and means.
There were 357 trauma patients that presented pre stay-at-home order and 480 that presented post stay-at-home order. Pre and post groups demonstrated differences in sex (35.6% vs 27.9% female; p = 0.02), age (47.4 ± 22.1 years vs 42 ± 20.3 years; p = 0.009), and race (1.4% vs 2.3% Asian; 63.3% vs 68.3% Black; 30.5% vs 22.3% White; and 4.8% vs 7.1% other; p = 0.03). Post stay-at-home order mechanism of injury revealed more intentional injury (p = 0.0008). Decreases in nonintentional trauma after adoption of social isolation paralleled declines in daily emergency department visits. Compared with earlier years, 2020 demonstrated a significantly greater proportion of intentional violent injury during the peripandemic months, especially from firearms.
Unprecedented social isolation policies to address COVID-19 were associated with increased intentional injury, especially gun violence. Meanwhile, emergency department and nonintentional trauma visits decreased. Pandemic-related public health measures should embrace intentional injury prevention and management strategies.
为了减少 COVID-19 的传播，采取了公共卫生措施。随后，急诊量总体减少，但受伤情况尚不清楚。随着封锁和社会隔离可能增加家庭纠纷，我们假设 COVID-19 期间故意受伤增加，主要是由于穿透性创伤增加。
对城市一级创伤中心急性成年患者护理进行回顾性审查，评估损伤模式。比较全州居家令（2020 年 3 月 16 日）前 6 周和后 10 周的就诊患者特征和诊断，并与 2015-2019 年进行比较。根据意图（故意与非故意）和损伤机制（钝器与穿透性）定义子集。采用 Fisher 精确检验和 Wilcoxon 检验比较比例和均值。
有 357 名创伤患者在居家令前就诊，480 名在居家令后就诊。预组和后组在性别（35.6% vs 27.9%女性；p=0.02）、年龄（47.4±22.1 岁 vs 42±20.3 岁；p=0.009）和种族（1.4% vs 2.3%亚裔；63.3% vs 68.3%黑人；30.5% vs 22.3%白人；4.8% vs 7.1%其他；p=0.03）方面存在差异。居家令后损伤机制显示更多的故意损伤（p=0.0008）。社会隔离措施实施后，非故意创伤减少与每日急诊就诊量下降一致。与前几年相比，2020 年在大流行期间，尤其是枪支造成的故意暴力伤害比例显著增加。
前所未有的社会隔离政策来应对 COVID-19 与故意受伤增加有关，尤其是枪支暴力。同时，急诊和非故意创伤就诊量减少。与大流行相关的公共卫生措施应包括故意伤害预防和管理策略。
