COVID-19: A national rise in penetrating trauma cared for by a prepared trauma system.

Background: The COVID-19 pandemic negatively impacted the collective American psyche. Socioeconomic hardships including social isolation led to an increase in firearm sales. Previous regional studies demonstrated increased penetrating trauma during the pandemic but it is unclear if trauma systems were prepared for this influx of penetrating injuries. This study aimed to confirm this increased penetrating trauma trend nationally and hypothesized penetrating trauma patients treated during the pandemic had a higher risk of complications and death, compared to pre-pandemic patients.

Methods: The 2017-2020 Trauma Quality Improvement Program database was divided into pre-pandemic (2017-2019) and pandemic years (2020). Bivariate analyses and a multivariable logistic regression analyses were performed controlling for age, comorbidities, injuries, and vitals on arrival.

Results: From 3,525,132 patients, 936,890 (26.6 %) presented during the pandemic. The pandemic patients had a higher rate of stab-wounds (4.8 % vs. 4.5 %,  > 0.001) and gunshot wounds (5.8 % vs. 4.6 %,  < 0.001) compared to pre-pandemic patients. Among penetrating trauma patients, the rate and associated risk of in-hospital complications (5.0 % vs. 5.1 %,  = 0.38) (OR 0.98, CI 0.94-1.02,  = 0.26) was similar between pre-pandemic and pandemic cohorts but adjusted risk of mortality decreased during the pandemic (8.3 % vs. 8.3 %,  = 0.45) (OR 0.92, CI 0.89-0.96,  < 0.001).

Conclusion: This national analysis confirms an increased rate of penetrating trauma during the COVID-19 pandemic, with a higher rate of gunshot injuries. However, this did not result in an increased risk of death or complications suggesting that trauma systems across the country were prepared to handle a dual pandemic of COVID and firearm violence.