UCI Health analysis shows increase in penetrating trauma related to COVID-19 stay-at-home changes

Gunshots are a “second pandemic”

March 02, 2021

A UCI Health-led study of trauma care in Southern California during the early months of the COVID-19 pandemic and “stay-at-home” period shows an increase in penetrating injuries such as gunshot wounds and a decrease in blunt trauma, usually associated with vehicle collisions and pedestrian injuries.

The multi-center analysis reviewed nearly 20,450 trauma patients treated at 11 American College of Surgeons-designated Level I and Level II trauma centers in seven counties in Southern California. The study, “Changes in Traumatic Mechanisms of Injury in Southern California Related to COVID-19: Penetrating Trauma as a Second Pandemic” published online in the Journal of Trauma & Acute Care Surgery, is the first large-scale analysis of the effect California’s March 2020 stay-at-home order had on this critical medical resource. 

“Our analysis identified a 21% increase in rates of penetrating trauma and a 24% increase in rates of gunshot wounds, but no significant increase in rates of suicide attempts or domestic violence that required trauma or critical care in the period after California’s stay-at-home order was issued in March 2020,” said Dr. Jeffry Nahmias, a UCI Medical Center trauma surgeon and the study’s senior investigator with UCI Health surgery resident Dr. Eric Yeates. 

Penetrating trauma is defined as an injury caused by an object breaking the skin and entering the body, such as a gunshot wound, stab wound or other types of impalement. The corresponding injuries can range in severity from superficial punctures to penetration of the head, abdomen or areas with large blood vessels, resulting in damage to major systems. Level I and II trauma centers are best equipped to treat penetrating injuries but are often a scarce resource in many parts of the United States. 

“One potential explanation for this increase in penetrating trauma is a rise in economic and psychological pressures experienced during the pandemic,” Nahmias said, noting that California’s unemployment rate had risen to 16% during 2020.

Effect on trauma center demand

As the largest study to date on this topic, the analysis provides evidence that these injuries created a second pandemic for a stretched Southern California healthcare system. The research team analyzed trauma demand during the three-month periods before and after the spring 2020 stay-at home order was issued and compared the results to the same period in 2019.

Penetrating injuries typically comprises a minority of traumas but have a much higher operation rate, making it both labor- and resource-intensive for a trauma center. Understanding how a major societal disruption such as the COVID-19 pandemic affects the demand for trauma care can help health systems better prepare to meet the public’s needs.

Nahmias said several recent single-center studies across the country have also suggested an increase in traumatic injuries related to suicide attempts and domestic violence during the stay-at-home period. 

“These remain critical public health concerns, but our multi-center analysis did not bear out an increase, however this study only captures the most violent incidents that would be seen at a major trauma center,” he said. 

Nahmias noted the study has some inherent limitations but provides the impetus for further analysis of the COVID-19 pandemic’s changing demands on such a critical resource as trauma care.

“We believe this knowledge highlights the need for robust community- and hospital-based violence prevention programs that continue to operate at full capacity during the current or future pandemics,” he said.

Stop the Bleed: You can make a difference

While top trauma centers like UCI Medical Center have the expertise and resources to save individuals with penetrating injuries, members of the public can help to improve the chances someone will survive such an injury. UCI Health is a champion of Stop the Bleed, a program of the American College of Surgeons that seeks to train civilians to properly respond when someone nearby is severely injured.

“Learning how to apply a tourniquet and slow or stop excessive bleeding, even before an ambulance arrives, can mean the difference between life and death and recovery or permanent disability from a life-threatening injury,” said Nahmias, director of the program at UCI Medical Center. 

Prior to the COVID pandemic, UCI Health conducted regular Stop the Bleed training sessions and large-scale training for school districts and other organizations. 

“We look forward to restarting the program as the pandemic slows and are currently developing a virtual class to continue this effort,” Nahmias said. “This kind of training is easy for anyone to learn and can really make a difference in saving a life.”

Participating institutions/trauma centers include:

  • UCI Medical Center
  • University of Southern California/Los Angeles County-USC Medical Center
  • Cedars-Sinai Medical Center
  • Ronald Reagan UCLA Medical Center 
  • Loma Linda University Medical Center
  • UC Riverside/Riverside University Health System 
  • UC San Diego Medical Center
  • Sharp Memorial Hospital/San Diego
  • Scripps Memorial Hospital/La Jolla
  • Ventura County Medical Center
  • Santa Barbara Cottage Hospital

UCI Health is the clinical enterprise of the University of California, Irvine. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center in Orange, California. The 418-bed acute care hospital provides tertiary and quaternary care, ambulatory and specialty medical clinics, as well as behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.

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