一项针对美国创伤中心的多中心研究，旨在考察新冠疫情对损伤原因、诊断及治疗程序的影响。
Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures.
作者信息
Salottolo Kristin, Caiafa Rachel, Mueller Jalina, Tanner Allen, Carrick Matthew M, Lieser Mark, Berg Gina, Bar-Or David
机构信息
Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.
Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA.
出版信息
Trauma Surg Acute Care Open. 2021 Apr 2;6(1):e000655. doi: 10.1136/tsaco-2020-000655. eCollection 2021.
BACKGROUND
The COVID-19 pandemic resulted in nationwide social distancing and shelter-in-place orders meant to curb transmission of the SARS-CoV-2 virus. The effect of the pandemic on injury patterns has not been well described in the USA. The study objective is to determine the effect of the COVID-19 pandemic on the distribution and determinants of traumatic injuries.
METHODS
This retrospective multi-institutional cohort study included all hospital admissions for acute traumatic injury at six community level I trauma centers. Descriptive statistics were used to compare injury causes, diagnoses and procedures over two similar time periods: prepandemic (March 11-June 30, 2019) and pandemic (March 11-June 30, 2020).
RESULTS
There were 7308 trauma patients included: 3862 (53%) prepandemic and 3446 (47%) during the pandemic. Cause of injury significantly differed by period (p<0.001). During the pandemic, there were decreases in motor vehicle crashes (from 17.0% to 14.0%, p<0.001), worksite injuries (from 5.2% to 4.1%, p=0.02), pedestrian injuries (from 3.0% to 2.2%, p=0.02) and recreational injuries (from 3.0% to 1.7%, p<0.001), while there were significant increases in assaults (6.9% to 8.5%, p=0.01), bicycle crashes (2.8% to 4.2%, p=0.001) and off-road vehicle injuries (1.8% to 3.0%, p<0.001). There was no change by study period in falls, motorcycle injuries, crush/strikes, firearm and self-inflicted injuries, and injuries associated with home-improvement projects. Injury diagnoses differed between time periods; during the pandemic, there were more injury diagnoses to the head (23.0% to 27.3%, p<0.001) and the knee/leg (11.7% to 14.9%, p<0.001). There were also increases in medical/surgical procedures (57.5% to 61.9%, p<0.001), administration of therapeutics/blood products (31.4% to 34.2%, p=0.01) and monitoring (11.0% to 12.9%, p=0.01).
DISCUSSION
Causes of traumatic injury, diagnoses, and procedures were significantly changed by the pandemic. Trauma centers must adjust to meet the changing demands associated with altered injury patterns, as they were associated with increased use of hospital resources.
LEVEL OF EVIDENCE
III (epidemiological).
背景
新冠疫情导致全国范围内实施社交距离措施和就地避难令，旨在遏制严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的传播。在美国，疫情对损伤模式的影响尚未得到充分描述。本研究的目的是确定新冠疫情对创伤性损伤的分布和决定因素的影响。
方法
这项回顾性多机构队列研究纳入了六个一级社区创伤中心所有因急性创伤性损伤而住院的患者。采用描述性统计方法比较两个相似时间段内的损伤原因、诊断和治疗程序：疫情前（2019年3月11日至6月30日）和疫情期间（2020年3月11日至6月30日）。
结果
共纳入7308例创伤患者，其中疫情前3862例（53%），疫情期间3446例（47%）。不同时期的损伤原因有显著差异（p<0.001）。疫情期间，机动车碰撞伤有所减少（从17.0%降至14.0%，p<0.001），工作场所受伤有所减少（从5.2%降至4.1%，p=0.02），行人受伤有所减少（从3.0%降至2.2%，p=0.02），娱乐性损伤有所减少（从3.0%降至1.7%，p<0.001），而袭击伤显著增加（从6.9%增至8.5%，p=0.01），自行车碰撞伤显著增加（从2.8%增至4.2%，p=0.001），越野车辆损伤显著增加（从1.8%增至3.0%，p<0.001）。研究期间，跌倒、摩托车损伤、挤压/撞击伤、火器伤、自残伤以及与家庭装修项目相关的损伤没有变化。不同时期的损伤诊断有所不同；疫情期间，头部损伤诊断增加（从23.0%增至27.3%，p<0.001），膝/腿部损伤诊断增加（从11.7%增至14.9%，p<0.001）。医疗/外科手术、治疗药物/血液制品的使用以及监测也有所增加（分别从57.5%增至61.9%，p<0.001；从31.4%增至34.2%，p=0.01；从11.0%增至12.9%，p=0.01）。
讨论
疫情显著改变了创伤性损伤的原因、诊断和治疗程序。创伤中心必须做出调整，以满足与改变的损伤模式相关的不断变化的需求，因为这些变化与医院资源使用的增加有关。
证据级别
III级（流行病学）
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