Medical College of Wisconsin, Milwaukee, WI, USA; American College of Surgeons, Chicago, IL, USA.
American College of Surgeons, Chicago, IL, USA; Department of Pediatric Surgery, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford, CT, USA.
Injury. 2022 Nov;53(11):3655-3662. doi: 10.1016/j.injury.2022.09.012. Epub 2022 Sep 13.
The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic.
All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect.
There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).
新冠疫情对美国医疗体系产生了诸多负面影响。许多州发布了居家令以减缓新冠病毒的传播。我们分析了居家令对新冠疫情第一波期间创伤中心入院患者创伤机制类型和数量的影响。
选取美国外科医师学会创伤质量改进计划参与中心 2018 年 1 月至 2020 年 9 月收治的 16 岁及以上创伤患者。比较每年居家令对应时期每周的创伤患者数量、患者人口统计学特征和损伤特征。采用具有医院随机效应的谐波回归对患者数量进行建模。
2020 年居家令发布后共收治 166773 例患者，474 家中心 2018-2019 年同期平均收治 160962 例患者。因酒精滥用导致的既往疾病患者增加（13611 例（8.3%）比 10440 例（6.6%），p<0.001）。伤害类型中，袭击伤增加（19056 例（11.4%）比 15605 例（9.8%））和与枪支相关的损伤（14246 例（8.5%）比 10316 例（6.4%）），p<0.001。特定枪支的袭击伤增加（10748 例（75.5%）比 7600 例（74.0%）），特定枪支的非故意损伤也增加（1318 例（9.3%）比 830 例（8.1%）），p<0.001。居家令发布前一个月，创伤中心入院人数减少。居家令实施后一周内，医院入院人数增加（p<0.001），直到 10 周后达到高于预测水平的平台期。在区域亚组分析中，居家令实施后第 11-25 周，中西部地区的入院人数仍显著升高（p<0.001）。
