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Tan H, Shipley J, Park FS, Donnelly MR, Kong AP, Barrios C, Grigorian A, Nahmias J. Firearm Violence Involving Adults 65 and Older During the Novel Coronavirus Disease Pandemic. Am Surg 2024; 90:345-349. [PMID: 37669124 DOI: 10.1177/00031348231200672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Rates of firearm violence (FV) surged during the COVID-19 pandemic. However, there is a paucity of data regarding older adults (OAs) (≥65 years old). This study aimed to evaluate patterns of FV against OAs before and after the COVID-19 pandemic, hypothesizing decreased firearm incidents, injuries, and deaths for OAs due to restricted social movement. METHODS Retrospective (2016-2021) data for OAs were obtained from the Gun Violence Archive. The rate of FV was weighted per 10,000 OAs using annual population data from the United States Census Bureau. Mann-Whitney U tests were performed to compare annual firearm incidence rates, number of OAs killed, and number of OAs injured from 2016-2020 to 2021. RESULTS From 944 OA-involved shootings, 842 died in 2021. The median total firearm incidents per month per 10,000 OAs decreased in 2021 vs 2016 (.65 vs .38, P < .001), 2017 (.63 vs .38, P < .001), 2018 (.61 vs .38, P < .001), 2019 (.39 vs .38, P = .003), and 2020 (.43 vs .38, P = .012). However, there was an increased median number of OAs killed in 2021 vs 2020 (.38 vs .38, P = .009), but no difference from 2016-2019 vs 2021 (all P > .05). The median number of firearm injuries decreased from 2017 to 2021 (.21 vs .19, P = .001) and 2020 to 2021 (.19 vs .19 P < .001). DISCUSSION Firearm incidents involving OAs decreased in 2021 compared to pre-pandemic years; however, there was a slight increase in deaths compared to 2020. This may reflect increased social isolation; however, future research is needed to understand why this occurred.
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Affiliation(s)
- Heidi Tan
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jonathan Shipley
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Flora S Park
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Megan R Donnelly
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Allen P Kong
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Cristobal Barrios
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
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Paladugu A, Shipley J, Grigorian A, Qazi A, Kong A, Kuza C, Donnelly M, Nahmias J. Trends in Legal Firearm Transactions: A Possible Protective Role of Gun Law Strength. Am Surg 2024:31348241230090. [PMID: 38266390 DOI: 10.1177/00031348241230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The United States (US) holds the highest personal firearm ownership among industrialized nations, with implications for firearm-related deaths tied to increased per capita gun ownership and varying gun laws. This study examines the influence of gun law strength on legal firearm transactions, positing a correlation between stronger laws and reduced transactions. The analysis, focused on the stress-laden COVID-19 pandemic, evaluates handgun, long gun, and multiple gun transactions in 2020 and 2021 compared to 2018-2019. METHODS The Giffords Gun Law scorecard categorized states into the top 25 "strong" and bottom 25 "weak" gun law groups. Multivariate linear regressions assessed the association between strong gun law states and monthly National Instant Criminal Background Check System (NICS) data from 2018 to 2021. The study queried NICS for handgun, long gun, and multiple gun transactions, comparing median monthly transactions in 2018 and 2019 to 2020 and 2018-2020 to 2021. RESULTS When evaluating gun law strength through multivariate linear regression models, stronger gun law states had fewer monthly NICS transactions for handguns, long guns, and multiple guns in 2020 and 2021 versus all comparison years (all P < .05). However, from 2018-2019 to 2020 and 2018-2020 to 2021, median monthly NICS transactions per 100,000 people for all gun types increased (all P < .05). CONCLUSION Stricter gun laws correlated with decreased firearm transactions in stronger law states, yet handgun, long gun, and multiple gun transactions increased during the pandemic years of 2020 and 2021. Therefore, strengthening firearm legislation may be protective against the proliferation of firearms, which warrants further research.
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Affiliation(s)
- Anushka Paladugu
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Jonathan Shipley
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Alliya Qazi
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Allen Kong
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Catherine Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA
| | - Megan Donnelly
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Orange, CA, USA
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Ruhi-Williams P, Yeates EO, Nahmias J. Letter re: Response to Letter to the Editor Regarding "Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else?". Am Surg 2024; 90:172. [PMID: 36070883 DOI: 10.1177/00031348221124333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scally GL, Sheets NW, Dubina E, Chawla-Kondal B, Plurad DS. Pediatric Trauma During the COVID-19 Pandemic: A 3-year Retrospective Analysis. Clin Pediatr (Phila) 2024; 63:47-52. [PMID: 37715697 DOI: 10.1177/00099228231201250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic has significantly impacted the volume and types of trauma patients encountered. We performed a retrospective analysis of pediatric trauma patients <17 years old presenting within a large US health care system from 2019 to 2021. Demographics, trauma volume, injury severity, mechanism of injury, and outcomes were compared. A total of 16 966 patients, from 88 hospitals over 18 states, were included in our analysis. Pediatric traumas decreased from 2019 to 2020 and 2021. The injury severity scores (ISSs) increased from 2019 to 2020 and 2019 to 2021. Compared with 2019, more gun-related traumas occurred in both 2020 and 2021, whereas motor vehicle collisions decreased. There were additional changes in bicycle, assault, auto versus pedestrian (AVP), playground, and sports injuries. The COVID-19 pandemic has impacted the volume, injury severity, and mechanism of injury of the pediatric trauma population.
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Affiliation(s)
- Gabriel L Scally
- General Surgery Residency Program, Riverside Community Hospital, Riverside, CA, USA
| | | | - Emily Dubina
- Riverside Community Hospital, Riverside, CA, USA
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Manasa M, Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Tay-Lasso E, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. Am Surg 2023; 89:6053-6059. [PMID: 37347234 DOI: 10.1177/00031348221124329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS. METHODS A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed. RESULTS 5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001). CONCLUSION This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.
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Affiliation(s)
- Morgan Manasa
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Riverside University Health System, Moreno Valley, CA, USA
| | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | | | - Erika Tay-Lasso
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
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Sullivan TM, Scheese D, Jain E, Milestone ZP, Haynes J, Boomer LA. Injury Patterns and Outcomes at a Single Pediatric Trauma Center During the Coronavirus Disease 19 Pandemic. J Surg Res 2023; 292:123-129. [PMID: 37619496 PMCID: PMC10285201 DOI: 10.1016/j.jss.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The coronavirus disease 19 (COVID-19) pandemic is reported to have changed injury patterns, prevalence, and outcomes across multiple institutions in the United States. Interpretation of aggregate data is difficult because injury patterns vary between urban and rural hospitals and the implementation of locoregional public health policies and guidelines in response to COVID-19 differed. To prepare our trauma system for future societal shutdowns, we compared injury patterns and outcomes of injured children and adolescents at a single pediatric trauma center before and during the first 2 y of the COVID-19 pandemic. METHODS We abstracted demographic, injury, and outcome data for injured children and adolescents (age <15 y) who required admission using our hospital trauma registry and the electronic medical record. We compared differences prior to and during the COVID-19 pandemic using univariate analysis. To address confounding variables, we also analyzed in-hospital mortality using a multivariable regression. RESULTS We observed an increase in the number of injured children requiring admission during the first year of the COVID-19 pandemic compared to the prepandemic era. Among injury types sustained, we observed an increase in firearm and nonfirearm related penetrating injuries (P < 0.001) during the first year, but not the second year, of the COVID-19 pandemic. Controlling for several confounding variables, we also observed an increase in in-hospital mortality (P = 0.04) during the first year of the COVID-19 pandemic. CONCLUSIONS The psychosocial and socioeconomic burden of the COVID-19 pandemic may have contributed to the rise in penetrating injuries and the odds of in-hospital mortality among a cohort of children and adolescents who were admitted to our hospital following injury. This data may be used to prepare our trauma system for future societal shutdowns through data informed resource utilization.
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Affiliation(s)
- Travis M Sullivan
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Daniel Scheese
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Eisha Jain
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Jeffrey Haynes
- Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura A Boomer
- Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
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Georgeades C, Collings AT, Farazi M, Bergner C, Fallat ME, Minneci PC, Speck KE, Van Arendonk KJ, Deans KJ, Falcone RA, Foley DS, Fraser JD, Gadepalli SK, Keller MS, Kotagal M, Landman MP, Leys CM, Markel TA, Rubalcava NS, St Peter SD, Sato TT, Flynn-O'Brien KT. Relationship between the COVID-19 pandemic and structural inequalities within the pediatric trauma population. Inj Epidemiol 2023; 10:62. [PMID: 38017506 PMCID: PMC10683076 DOI: 10.1186/s40621-023-00475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted social, political, and economic life across the world, shining a light on the vulnerability of many communities. The objective of this study was to assess injury patterns before and after implementation of stay-at-home orders (SHOs) between White children and children of color and across varying levels of vulnerability based upon children's home residence. METHODS A multi-institutional retrospective study was conducted evaluating patients < 18 years with traumatic injuries. A "Control" cohort from an averaged March-September 2016-2019 time period was compared to patients injured after SHO initiation-September 2020 ("COVID" cohort). Interactions between race/ethnicity or social vulnerability index (SVI), a marker of neighborhood vulnerability and socioeconomic status, and the COVID-19 timeframe with regard to the outcomes of interest were assessed using likelihood ratio Chi-square tests. Differences in injury intent, type, and mechanism were then stratified and explored by race/ethnicity and SVI separately. RESULTS A total of 47,385 patients met study inclusion. Significant interactions existed between race/ethnicity and the COVID-19 SHO period for intent (p < 0.001) and mechanism of injury (p < 0.001). There was also significant interaction between SVI and the COVID-19 SHO period for mechanism of injury (p = 0.01). Children of color experienced a significant increase in intentional (COVID 16.4% vs. Control 13.7%, p = 0.03) and firearm (COVID 9.0% vs. Control 5.2%, p < 0.001) injuries, but no change was seen among White children. Children from the most vulnerable neighborhoods suffered an increase in firearm injuries (COVID 11.1% vs. Control 6.1%, p = 0.001) with children from the least vulnerable neighborhoods having no change. All-terrain vehicle (ATV) and bicycle crashes increased for children of color (COVID 2.0% vs. Control 1.1%, p = 0.04 for ATV; COVID 6.7% vs. Control 4.8%, p = 0.02 for bicycle) and White children (COVID 9.6% vs. Control 6.2%, p < 0.001 for ATV; COVID 8.8% vs. Control 5.8%, p < 0.001 for bicycle). CONCLUSIONS In contrast to White children and children from neighborhoods of lower vulnerability, children of color and children living in higher vulnerability neighborhoods experienced an increase in intentional and firearm-related injuries during the COVID-19 pandemic. Understanding inequities in trauma burden during times of stress is critical to directing resources and targeting intervention strategies.
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Affiliation(s)
- Christina Georgeades
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA.
| | | | - Manzur Farazi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA
| | - Carisa Bergner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA
| | - Mary E Fallat
- Norton Children's Hospital, Louisville, KY, USA
- Hiram C. Polk Jr., Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - K Elizabeth Speck
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, USA
| | - Kyle J Van Arendonk
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Foley
- Norton Children's Hospital, Louisville, KY, USA
- Hiram C. Polk Jr., Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Samir K Gadepalli
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, USA
| | - Martin S Keller
- Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Troy A Markel
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Nathan S Rubalcava
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Thomas T Sato
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA
| | - Katherine T Flynn-O'Brien
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA
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Kannikeswaran N, Ehrman RR, Vitale L, Oag K, Sundaralingam S, Spencer P, Donoghue L, Sethuraman U. Comparison of Trauma and Burn Evaluations in a Pediatric Emergency Department During Pre, Early and Late COVID-19 Pandemic. J Pediatr Surg 2023; 58:1803-1808. [PMID: 37032192 PMCID: PMC10019029 DOI: 10.1016/j.jpedsurg.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Pediatric trauma epidemiology altered during early COVID-19 pandemic period but the impact of the ongoing pandemic is unknown. OBJECTIVES To compare pediatric trauma epidemiology between the pre, early and late pandemic periods and to evaluate the association of race and ethnicity on injury severity during the pandemic. METHODS We performed a retrospective study of trauma consults for an injury/burn in children ≤16 years between January 1, 2019 and December 31, 2021. Study period was categorized into pre (January 1, 2019-February 28, 2020), early (March 1, 2020-December 31, 2020), and late (January 1, 2021-December 31, 2021) pandemic. Demographics, etiology, injury/burn severity, interventions and outcomes were noted. RESULTS A total of 4940 patients underwent trauma evaluation. Compared to pre-pandemic, trauma evaluations for injuries and burns increased during both the early (RR: 2.13, 95% CI: 1.6-2.82 and RR: 2.24, 95% CI: 1.39-3.63, respectively) and late pandemic periods (RR: 1.42, 95% CI: 1.09-1.86 and RR: 2.44, 95% CI: 1.55-3.83, respectively). Severe injuries, hospital admissions, operations and death were higher in the early pandemic but reverted to pre-pandemic levels during late pandemic. Non-Hispanic Blacks had an approximately 40% increase in mean ISS during both pandemic periods though they had lower odds of severe injury during both pandemic periods. CONCLUSIONS Trauma evaluations for injuries and burns increased during the pandemic periods. There was a significant association of race and ethnicity with injury severity which varied with pandemic periods. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Nirupama Kannikeswaran
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E. Canfield Ave Detroit, MI 48201, USA
| | - Lisa Vitale
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Katherine Oag
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | | | - Priya Spencer
- Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Lydia Donoghue
- Department of Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Usha Sethuraman
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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Evaluating the regional differences in pediatric injury patterns during the COVID-19 pandemic. J Surg Res 2023; 289:61-68. [PMID: 37086597 PMCID: PMC10033255 DOI: 10.1016/j.jss.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/18/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Background Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across Pediatric Trauma Centers (PTCs) in the United States. Materials and Methods A multicenter, retrospective study evaluating patients <18-years-old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after Stay-at-Home Orders through September 2020 (“COVID” cohort) were compared to “Historical” controls from an averaged period of equivalent dates in 2016–2019. Differences in injury type, intent, and mechanism were explored at the site level. Results 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7,068 patients vs. Historical 5,891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from 110% increase to a 69% decrease. Conclusions There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at PTCs is warranted to be better prepared for future environmental stressors.
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10
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Iantorno SE, Swendiman RA, Bucher BT, Russell KW. Surge in Pediatric Firearm Injuries Presenting to US Children's Hospitals During the COVID-19 Pandemic. JAMA Pediatr 2022; 177:204-206. [PMID: 36534391 PMCID: PMC9856622 DOI: 10.1001/jamapediatrics.2022.4881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This cohort study uses administrative health data to evaluate trends in pediatric firearm injuries before and during the COVID-19 pandemic.
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Affiliation(s)
- Stephanie E. Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Robert A. Swendiman
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Brian T. Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Katie W. Russell
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
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Bernardin ME, Clukies L, Gu H, Fairfax C, Keller MS. COVID-19 Pandemic effects on the epidemiology and mortality of pediatric firearm injuries; A single center study. J Pediatr Surg 2022:S0022-3468(22)00678-9. [PMID: 36402591 PMCID: PMC9596183 DOI: 10.1016/j.jpedsurg.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased firearm injuries amongst adults, though the pandemic's effect on children is less clearly understood. METHODS This cross-sectional study was performed at a Level 1 Pediatric Trauma Center and included youths 0-19 years. The trauma registry was retrospectively queried for firearm injuries occurring pre-COVID-19 pandemic (March 2015-February 2020). Baseline data was compared to prospectively collected data occurring during the COVID-19 pandemic (March 2020-March 2022). Fischer's exact, Pearson's Chi-square and/or correlation analysis was used to compare pre and post-COVID-19 firearm injury rates and intent, victim demographics and disposition. Temporal relationships between firearm injury rates and local COVID-19 death rates were also described. RESULTS 413 pre-COVID-19 firearm injuries were compared to 259 pandemic firearm injuries. Victims were mostly Black males with a mean age of 13.4 years. Compared to the 5 years pre-pandemic, monthly firearm injury rates increased 51.5% (6.8 vs 10.3 shootings/month), including a significant increase (p = 0.04) in firearm assaults/homicides and a relative decrease in unintentional shootings. Deaths increased 29%, and there were significantly fewer ED discharges and more admissions to OR and/or PICU (p = 0.005). There was a significant increase in Black victims (p = 0.01) and those having Medicaid or self-pay (p<0.001). Firearm injury spikes were noted during or within the 3 months following surges in local COVID-19 death rates. CONCLUSIONS The COVID-19 pandemic was associated with an increase in the frequency and mortality of pediatric firearm injuries, particularly assaults amongst Black children following surges in COVID death rates. Increased violence-intervention services are needed, particularly amongst marginalized communities. LEVEL OF EVIDENCE This is a prognostic study, evaluating the effects of the COVID-19 pandemic on pediatric firearm injuries, including victim demographics, injury intent and mortality. This study is retrospective and observational, making it Oxford Level III evidence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO, USA; Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Lindsay Clukies
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongjie Gu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Martin S Keller
- Division of Pediatric Surgery, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Wieck MM, Silva T, Kohler JE. Changing Patterns of Pediatric Trauma During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e286-e290. [PMID: 35858219 DOI: 10.3928/19382359-20220504-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At the start of the pandemic, the number of injured children evaluated at trauma centers decreased. Trauma volumes have since rebounded, and a concerning increase in abuse-related injuries has been seen. Pediatric trauma systems responded to the pandemic with new approaches to protect health care providers, conserve critical resources, and assist adult trauma systems overburdened by patients with COVID-19. The widespread effect of COVID-19 continues to have significant repercussions on children's health, but the lessons learned and gaps exposed by the pandemic may be an opportunity to positively transform injury prevention and health care delivery. [Pediatr Ann. 2022;51(7):e286-e290.].
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13
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Ruhi-Williams P, Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else? Am Surg 2022; 88:2429-2435. [PMID: 35583103 PMCID: PMC9127450 DOI: 10.1177/00031348221101475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social
interactions affect development. This has the potential to change adolescent
trauma. A post-hoc multicenter retrospective analysis of adolescent
(13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed.
Patients were divided into 3 groups based on injury date: historical control
(CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH
(POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL
groups in separate analyses. 726 ATPs were identified across the 3
time periods. POST had a similar penetrating trauma rate compared to both PRE
(15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%,
P = .69). POST also had a similar rate of suicide attempts
compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2%
vs 2.1%, P = .43). However, POST had a higher rate of drug
positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but
was similar in all other comparisons of alcohol and drugs to PRE and POST
periods (all P > .05). Hence ATPs were affected differently
than adults and children, as they had a similar rate of penetrating trauma,
suicide attempts, and alcohol positivity after SAH orders. However, they had
increased drug positivity compared to the CONTROL, but not PRE group.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA.,Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA.,472028Riverside University Health System Medical CenterUniversity, Moreno Valley, CA, USA
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, 21380Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Justine Chinn
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
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