P. Jalihal2, C. Annesi1, S. Morris2, M. Zhu2, A. Zhuang2, K. McCord2, A. Buck3,4, L. Allee4,5 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2Boston University Chobanian And Avedisian School Of Medicine, Boston, MA, USA 3Boston University Chobanian And Avedisian School Of Medicine, Department Of Graduate Medical Education, Boston, MA, USA 4Boston Medical Center, Department Of Surgery, Boston, MA, USA 5Boston University Chobanian And Avedisian School Of Medicine, Department Of Surgery, Boston, MA, USA
Introduction: The rate of firearm injuries increased in the first year of the COVID-19 pandemic. This study aims to examine the association between firearm injury outcomes at a Level I trauma center pre- and post-Massachusetts (MA) COVID-19 stay-at-home orders (SAHO).
Methods: This is a retrospective single-institution study of adult MA residents treated for gunshot wounds (GSW) at a Level I Trauma Center between 2015-2021, grouped by date of GSW: pre-SAHO or post-SAHO for MA (March 24, 2020). MA Area Deprivation Index (ADI) rank was assigned by patient address and analyzed continuously and categorically in quartiles (lowest 25% MA ADI, 26-50%, 51-75%, and 76-100%). Univariate and multivariate analyses were performed.
Results: There were 672 pre-SAHO and 276 post-SAHO patients. Pre-SAHO patients were significantly older than post-SAHO patients (31.1 vs. 28.7 years, p<0.001). In both cohorts, patients were predominantly male (90% vs 92%), of Black race (74% vs 72%), and of non-Hispanic/Latino ethnicity (83% vs 80%). Mean state ADI was similar between cohorts (2.2 vs 2.3, p=0.59). Rates of ICU admission were significantly higher pre-SAHO compared to post-SAHO (23.8% vs 16.3%, p=0.01). Rates of Emergency Department (ED) visits and readmission 30 days post-discharge were not significantly different in pre- and post-SAHO patients in univariate and multivariate analyses.
Conclusion: While the COVID-19 pandemic saw increased rates of firearm violence, at our Level I trauma center there was no increase in 30-day ED visits or readmissions when comparing pre and post-SAHO. Lower ICU admission rates for GSW patients post-SAHO may reflect triaging decisions made under crisis standard of care protocols implemented in hospitals to address resource scarcity.