Journal of Trauma and Injury

Original Articles

Changes in interpersonal violence and utilization of trauma recovery services at an urban trauma center in the United States during the COVID-19 pandemic: a retrospective, comparative study: Kevin Y. Zhu, Kristie J. Sun, Mary A. Breslin, Mark Kalina Jr., Tyler Moon, Ryan Furdock, Heather A. Vallier; J Trauma Inj. 2024;37(1):60-66. Published online February 26, 2024; DOI: https://doi.org/10.20408/jti.2023.0064

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Abstract PDF: Purpose
This study investigated changes in interpersonal violence and utilization of trauma recovery services during the COVID-19 pandemic. At an urban level I trauma center, trauma recovery services (TRS) provide education, counseling, peer support, and coordination of rehabilitation and recovery to address social and mental health needs. The COVID-19 pandemic prompted considerable changes in hospital services and increases in interpersonal victimization.
Methods
A retrospective analysis was conducted between September 6, 2018 and December 20, 2020 for 1,908 victim-of-crime patients, including 574 victims of interpersonal violence. Outcomes included length of stay associated with initial TRS presentation, number of subsequent emergency department visits, number of outpatient appointments, and utilization of specific specialties within the year following the initial traumatic event.
Results
Patients were primarily female (59.4%), single (80.1%), non-Hispanic (86.7%), and Black (59.2%). The mean age was 33.0 years, and 247 patients (49.2%) presented due to physical assault, 132 (26.3%) due to gunshot wounds, and 76 (15.1%) due to sexual assault. The perpetrators were primarily partners (27.9%) or strangers (23.3%). During the study period, 266 patients (mean, 14.9 patients per month) presented before the declaration of COVID-19 as a national emergency on March 13, 2020, while 236 patients (mean, 25.9 patients per month) presented afterward, representing a 74.6% increase in victim-of-crime patients treated. Interactions with TRS decreased during the COVID-19 period, with an average of 3.0 interactions per patient before COVID-19 versus 1.9 after emergency declaration (P<0.01). Similarly, reductions in length of stay were noted; the pre–COVID-19 average was 3.6 days, compared to 2.1 days post–COVID-19 (P=0.01).
Conclusions
While interpersonal violence increased, TRS interactions decreased during the COVID-19 pandemic, reflecting interruption of services, COVID-19 precautions, and postponement/cancellation of elective visits. Future direction of hospital policy to enable resource and service delivery to this population, despite internal and external challenges, appears warranted.; Summary

Comparison of pediatric injury patterns before and during the COVID-19 pandemic in Korea: a retrospective study: Geom Pil Nam, Woo Sung Choi, Jin-Seong Cho, Yong Su Lim, Jae-Hyug Woo, Jae Ho Jang, Jea Yeon Choi; J Trauma Inj. 2023;36(4):343-353. Published online December 22, 2023; DOI: https://doi.org/10.20408/jti.2023.0053

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Abstract PDF Supplementary Material: Purpose
The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic.
Methods
This study is based on the data of patients who presented with injuries at 24 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year.
Results
The study periods were March 12, 2018, to December 31, 2019 (pre–COVID-19 period) and March 12, 2020, to December 31, 2021 (COVID-19 pandemic period). A total of 222,304 patients aged ≤15 years were included in the study. When comparing the COVID-19 pandemic period to the pre–COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (39.3% vs. 49.2%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%).
Conclusions
During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.; Summary

No frequency change of prehospital treatments by emergency medical services providers for traumatic cardiac arrest patients before and after the COVID-19 pandemic in Korea: an observational study: Ju Heon Lee, Hyung Il Kim; J Trauma Inj. 2023;36(3):172-179. Published online August 2, 2023; DOI: https://doi.org/10.20408/jti.2023.0009

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Abstract PDF: Purpose
Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient’s COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea.
Methods
This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre–COVID-19 and all subsequent data (from 2020 and 2021) as post–COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated.
Results
During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre–COVID-19 and 404 (67.8%) were post–COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA.
Conclusions
Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.; Summary

Epidemiology of Facial Bone Fractures During the Coronavirus Disease 2019 Pandemic: A Single Korean Level I Trauma Center Study: Min Ji Kim, Kyung Min Yang, Hyoseob Lim; J Trauma Inj. 2021;34(4):233-241. Published online December 24, 2021; DOI: https://doi.org/10.20408/jti.2021.0098

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Abstract PDF

Purpose

The medical community has been heavily impacted by the coronavirus disease 2019 pandemic. The management of facial trauma patients has been affected by the patient capacity of emergency rooms. In this study, we share our experiences of facial trauma management during the social lockdown period and investigate the epidemiological changes in facial bone fractures.

Methods

A total of 997 patients who presented to Ajou University Hospital Emergency Center and were evaluated by plastic or maxillofacial surgeons for facial trauma were included in this retrospective study. Our study design was a comparative study of two groups: the 2019 group (control) and the 2020 group (the experimental group that experienced social lockdown).

Results

The total number of emergency room inpatients reflected the national pandemic trends with three peaks in patient numbers. According to these trends, facial bone fractures had two different low points in August 2020 and December 2020. A comparison of the 2019 and 2020 facial bone fractures did not show a statistically significant difference in the total number of patients. An analysis of the causes of trauma showed that domestic accidents increased in 2020 (30.92%; p<0.001). Among the anatomical sites of facial injury in surgical patients, the frontozygomatic complex fracture increased the most in 2020 (p=0.018). Facial injuries with two separate sites of injury or with three or more involved sites also showed a significant increase in 2020 (p<0.001).

Conclusions

We demonstrated that the incidence of facial trauma patients correlated with the incidence of patients presenting to the emergency department and that facial trauma is inextricably related to multi-trauma cases. Domestic accidents and facial trauma with multiple anatomically involved sites are increasing trends that need more attention.

Summary

Citations

Citations to this article as recorded by

Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
Myungjin Jang, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, Byungchul Yu
Healthcare.2023; 11(8): 1074. CrossRef
The Trend of Change in Oral and Maxillofacial Injuries of Pediatric Patients in the COVID-19 Pandemic: a Regional Emergency Medical Center and Dental Hospital Study
Suebin Choi, Chankue Park, Jonghyun Shin, Taesung Kim, Eungyung Lee
THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DEN.2023; 50(3): 318. CrossRef

The impact of COVID-19 on trauma patients and orthopedic trauma operations at a single focused training center for trauma in Korea: Wonseok Choi, Hanju Kim, Whee Sung Son, Seungyeob Sakong, Jun-Min Cho, Nak-Jun Choi, Tae-Wook Noh, Namryeol Kim, Jae-Woo Cho, Jong-Keon Oh; J Trauma Inj. 2022;35(3):195-201. Published online December 1, 2021; DOI: https://doi.org/10.20408/jti.2021.0078

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Abstract PDF: Purpose
The objective of this study was to determine the effects of coronavirus disease 2019 (COVID-19) on the volume of trauma patients, the number of orthopedic trauma operations, and the severity of injuries. We also investigated the correlations between social distancing and these variables.
Methods
This was a retrospective review of trauma patient cases at a single focused training center for trauma in Korea from January 2017 to April 2021. The COVID-19 group included patients treated from January 1 to April 30 in 2020 and 2021, and the control group included patients treated during the same months from 2017 to 2019. The volume of trauma patients according to the level of social distancing was evaluated among patients treated from August 2, 2020 to November 23, 2020.
Results
The study included 3,032 patients who presented to the emergency department with traumatic injuries from January to April 2017 to 2021. The average number of patients was 646.7 and 546.0 in the control and COVID-19 groups, respectively. The percentage of patients injured in traffic accidents (TAs) decreased from 25.0% to 18.2% (p<0.0001). The proportions of in-car TAs and pedestrian TAs also decreased from 6.7% and 10.8% to 3.5% and 6.0%, respectively (p=0.0002 and p<0.0001). The percentage of bicycle TAs increased from 2.4% to 4.0% (p=0.0128). The proportion of patients with an Injury Severity Score above 15 and the mortality rate did not change significantly. As the level of social distancing increased, the number of trauma patients and the number of trauma injuries from TAs decreased. The number of orthopedic trauma operations also depended on the social distancing level.
Conclusions
The number of trauma patients presenting to the emergency department decreased during the COVID-19 period. The volume of trauma patients and orthopedic trauma operations decreased as the social distance level increased.; Summary

Case Report

Experiences of Emergency Surgical Treatment for a COVID-19 Patient with Severe Traumatic Brain Injury at a Regional Trauma Center: A Case Report: Jung-Ho Yun; J Trauma Inj. 2021;34(3):212-217. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2021.0073

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Abstract PDF: Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-year-old male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient’s consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient’s transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.; Summary

Original Article

Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Outcomes among Patients with Polytrauma at a Single Regional Trauma Center in South Korea: Sun Hyun Kim, Dongyeon Ryu, Hohyun Kim, Kangho Lee, Chang Ho Jeon, Hyuk Jin Choi, Jae Hoon Jang, Jae Hun Kim, Seok Ran Yeom; J Trauma Inj. 2021;34(3):155-161. Published online June 4, 2021; DOI: https://doi.org/10.20408/jti.2020.0064

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9 Citations

Abstract PDF

Purpose

The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea.

Methods

We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS.

Results

The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p<0.001); however, no significant differences in ICU LOS and mortality were found.

Conclusions

The observations at Regional Trauma Center, Pusan National University Hospital corroborate anecdotal reports that there has been a decline in the number of patients admitted to hospitals during the COVID-19 period. In addition, patients admitted during the COVID-19 pandemic had a significantly shorter hospital LOS than those admitted before the COVID-19 pandemic. These preliminary data warrant validation in larger, multi-center studies.

Summary

Citations

Citations to this article as recorded by

Patientensicherheit bei differenzierter (innerklinischer) Schockraumaktivierung für Schwerverletzte
S. Hagel, K. R. Liedtke, S. Bax, S. Wailke, T. Klüter, P. Behrendt, G. M. Franke, A. Seekamp, P. Langguth, A. Balandin, M. Grünewald, D. Schunk
Die Unfallchirurgie.2023; 126(6): 441. CrossRef
Characteristics of Patients With Traumatic Brain Injury in a Regional Trauma Center: A Single-Center Study
Mahnjeong Ha, Seunghan Yu, Byung Chul Kim, Jung Hwan Lee, Hyuk Jin Choi, Won Ho Cho
Korean Journal of Neurotrauma.2023; 19(1): 6. CrossRef
Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
Myungjin Jang, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, Byungchul Yu
Healthcare.2023; 11(8): 1074. CrossRef
Análise do atendimento primário de pacientes vítimas de violência interpessoal e autodirigida durante a pandemia da COVID-19
HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub] CrossRef
Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic
HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub] CrossRef
Comparison of Clinical Characteristics of Traumatic Brain Injury Patients According to the Mechanism Before and After COVID-19
Jonghyun Sung, Jongwook Choi, Kum Whang, Sung Min Cho, Jongyeon Kim, Seung Jin Lee, Yeon gyu Jang
Korean Journal of Neurotrauma.2023; 19(3): 307. CrossRef
Outcomes improvement despite continuous visits of severely injured patients during the COVID-19 outbreak: experience at a regional trauma centre in South Korea
Sooyeon Kang, Ji Eun Park, Ji Wool Ko, Myoung Jun Kim, Young Un Choi, Hongjin Shim, Keum Seok Bae, Kwangmin Kim
BMC Emergency Medicine.2022;[Epub] CrossRef
Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study
ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Impacto da pandemia da COVID-19 na epidemiologia dos acidentes de trânsito: um estudo transversal
ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef

Case Report

Pulmonary Contusion Similar to COVID-19 Pneumonia: Seung Hwan Lee, Sung Youl Hyun, Yang Bin Jeon, Jung Nam Lee, Gil Jae Lee; J Trauma Inj. 2020;33(2):119-123. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0014

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214 Download
1 Citations

Abstract PDF

The Coronavirus disease 2019 (COVID-19) has rapidly spread across the world and caused a pandemic. It can be transmitted by an infected person or an asymptomatic carrier and is a highly contagious disease. Prevention and early identification of COVID-19 are important to minimize the transmission of COVID-19. Chest computed tomography (CT) has a high sensitivity for detecting COVID-19, but relatively low specificity. Therefore, chest CT may be difficult to distinguish COVID-19 findings from those of other infectious (notably viral types of pneumonia) or noninfectious disease. Pulmonary contusion has also a lot of similarities on chest CT with COVID-19 pneumonia. We present trauma patients with pulmonary contusion whose CT scans showed findings similar to those of COVID-19, and we report our experience in the management of trauma patients during the COVID-19 pandemic.

Summary

Citations

Citations to this article as recorded by

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims
Hossein Abdolrahimzadeh Fard, Salahaddin Mahmudi-Azer, Qusay Abdulzahraa Yaqoob, Golnar Sabetian, Pooya Iranpour, Zahra Shayan, Shahram Bolandparvaz, Hamid Reza Abbasi, Shiva Aminnia, Maryam Salimi, Mohammad Mehdi Mahmoudi, Shahram Paydar, Roham Borazjani
Chinese Journal of Traumatology.2022; 25(3): 170. CrossRef

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