{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T14:14:08Z","timestamp":1768572848461,"version":"3.49.0"},"posted":{"date-parts":[[2025,10,21]]},"group-title":"Epidemiology","reference-count":45,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,10,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Firearm injuries increased as the United States faced the onset and first two years of the COVID-19 pandemic, a phenomenon some refer to as the \u201cdual pandemic.\u201d Across the country, evidence suggests regional firearm injury rates and related mechanisms behind trends in firearm injury during this time differ, presumably according to local context. This study examines how one regional trauma system fared during the dual pandemic and explores potential explanatory mechanisms of the surge of firearm injuries during the COVID-19 period.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We used an interrupted time series model to compare quarterly data from 2016-2021 from the COTS (formerly known as the Central Ohio Trauma System) Regional Trauma Registry to examine the proportion of firearm injuries among all trauma cases, case mortality and rates of mistriage among firearm injuries, and the proportion of firearm injuries associated with substance use.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 3,727 firearm-injured patients, demographic characteristics did not vary with respect to firearm injury, mistriage, mortality, substance use, or alcohol use. Rates of firearm injuries presenting to COTS rose slightly from the beginning of 2020 Q2 (4.54%) through the end of 2020 Q4 (4.71%), and rates continued to grow and remained at a heightened level after the lockdown period. There was no significant change in the growth rate of firearm injuries between 2021 Q2 and 2021 Q3. From 2020 Q4 to 2021 Q2, rates of firearm injury rose 0.99% (CI: 0.05%, 1.9%) from the 2016 average (p&lt;0.05). Considering the entire period from 2016 to 2021, the lockdown period had effects on firearm injury rates that approached significance (p=0.059). There were no significant changes in the rates of undertriage, overtriage, mortality, substance use, or alcohol use. Length of stay did not significantly differ before and during the COVID period.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSION<\/jats:title>\n                  <jats:p>This Midwest regional trauma system was affected by the dual pandemic of increased firearm injury during the COVID-19 pandemic. However, the regional trauma system showed resilience, as patient care metrics did not experience significant deficits. Evidence suggests further research into the mechanisms behind significantly increased firearm injury in the region in several months of 2020.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.10.19.25338318","type":"posted-content","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T19:00:21Z","timestamp":1761073221000},"source":"Crossref","is-referenced-by-count":0,"title":["Dual pandemic of firearm injury and COVID-19 in Central and Southeastern Ohio: An interrupted time series analysis"],"prefix":"10.64898","author":[{"given":"Hannah","family":"Williams","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5412-4875","authenticated-orcid":false,"given":"Megan","family":"Armstrong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Groner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherri","family":"Kovach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanna","family":"Giambri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8112-319X","authenticated-orcid":false,"given":"Henry","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025102312101004000_2025.10.19.25338318v1.1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jamcollsurg.2020.09.028","article-title":"Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden","volume":"232","year":"2021","journal-title":"J Am Coll Surg"},{"key":"2025102312101004000_2025.10.19.25338318v1.2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-042697"},{"key":"2025102312101004000_2025.10.19.25338318v1.3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jss.2021.01.018","article-title":"A Dual Pandemic: The Influence of Coronavirus Disease 2019 on Trends and Types of Firearm Violence in California, Ohio, and the United States","volume":"263","year":"2021","journal-title":"J Surg Res"},{"key":"2025102312101004000_2025.10.19.25338318v1.4","unstructured":"Everytown (2021) Gun Violence and COVID-19 in 2020: A Year of Colliding Crises."},{"key":"2025102312101004000_2025.10.19.25338318v1.5","doi-asserted-by":"crossref","first-page":"e229393","DOI":"10.1001\/jamanetworkopen.2022.9393","article-title":"Analysis of Firearm Violence During the COVID-19 Pandemic in the US","volume":"5","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025102312101004000_2025.10.19.25338318v1.6","unstructured":"Davis A , Kim R , Crifasi CK (2023) A Year in Review: 2021 Gun Deaths in the U.S. Johns Hopkins Center for Gun Violence Solutions. 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