{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:56:57Z","timestamp":1779173817604,"version":"3.51.4"},"reference-count":35,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,3,12]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The COVID-19 pandemic resulted in nationwide social distancing and shelter-in-place orders meant to curb transmission of the SARS-CoV-2 virus. The effect of the pandemic on injury patterns has not been well described in the USA. The study objective is to determine the effect of the COVID-19 pandemic on the distribution and determinants of traumatic injuries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective multi-institutional cohort study included all hospital admissions for acute traumatic injury at six community level I trauma centers. Descriptive statistics were used to compare injury causes, diagnoses and procedures over two similar time periods: prepandemic (March 11\u2013June 30, 2019) and pandemic (March 11\u2013June 30, 2020).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 7308 trauma patients included: 3862 (53%) prepandemic and 3446 (47%) during the pandemic. Cause of injury significantly differed by period (p&lt;0.001). During the pandemic, there were decreases in motor vehicle crashes (from 17.0% to 14.0%, p&lt;0.001), worksite injuries (from 5.2% to 4.1%, p=0.02), pedestrian injuries (from 3.0% to 2.2%, p=0.02) and recreational injuries (from 3.0% to 1.7%, p&lt;0.001), while there were significant increases in assaults (6.9% to 8.5%, p=0.01), bicycle crashes (2.8% to 4.2%, p=0.001) and off-road vehicle injuries (1.8% to 3.0%, p&lt;0.001). There was no change by study period in falls, motorcycle injuries, crush\/strikes, firearm and self-inflicted injuries, and injuries associated with home-improvement projects. Injury diagnoses differed between time periods; during the pandemic, there were more injury diagnoses to the head (23.0% to 27.3%, p&lt;0.001) and the knee\/leg (11.7% to 14.9%, p&lt;0.001). There were also increases in medical\/surgical procedures (57.5% to 61.9%, p&lt;0.001), administration of therapeutics\/blood products (31.4% to 34.2%, p=0.01) and monitoring (11.0% to 12.9%, p=0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Causes of traumatic injury, diagnoses, and procedures were significantly changed by the pandemic. Trauma centers must adjust to meet the changing demands associated with altered injury patterns, as they were associated with increased use of hospital resources.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>III (epidemiological).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2020-000655","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T12:15:59Z","timestamp":1617365759000},"page":"e000655","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures"],"prefix":"10.1136","volume":"6","author":[{"given":"Kristin","family":"Salottolo","sequence":"first","affiliation":[{"name":"Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Caiafa","sequence":"additional","affiliation":[{"name":"Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jalina","family":"Mueller","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen","family":"Tanner","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew M","family":"Carrick","sequence":"additional","affiliation":[{"name":"Medical Center of Plano, Plano, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Lieser","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Research Medical Center, Kansas City, Missouri, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina","family":"Berg","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"2025081711173120000_6.1.e000655.1","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/acem.14051","article-title":"Effect of the coronavirus disease 2019 (COVID-19) pandemic on the U.S. emergency medical services system: a preliminary report","volume":"27","author":"Lerner","year":"2020","journal-title":"Acad Emerg Med"},{"key":"2025081711173120000_6.1.e000655.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6923e1"},{"key":"2025081711173120000_6.1.e000655.3","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000505"},{"key":"2025081711173120000_6.1.e000655.4","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1016\/j.injury.2020.06.040","article-title":"Development of an enhanced acute care surgery service in response to the COVID-19 global pandemic","volume":"51","author":"Mathur","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.5","first-page":"81","article-title":"Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand","volume":"133","author":"Christey","year":"2020","journal-title":"N Z Med J"},{"key":"2025081711173120000_6.1.e000655.6","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.injury.2020.05.039","article-title":"The epidemiology of trauma during a pandemic","volume":"51","author":"Balogh","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13017-020-00312-5","article-title":"Emergency trauma care during the outbreak of corona virus disease 2019 (COVID-19) in China","volume":"15","author":"Li","year":"2020","journal-title":"World J Emerg Surg"},{"key":"2025081711173120000_6.1.e000655.8","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/j.injury.2020.06.022","article-title":"Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study","volume":"51","author":"Lv","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.9","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s00264-020-04575-0","article-title":"Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China","volume":"44","author":"Zhu","year":"2020","journal-title":"Int Orthop"},{"key":"2025081711173120000_6.1.e000655.10","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1016\/j.burns.2020.05.008","article-title":"Restructuring burns management during the COVID-19 pandemic: a Malaysian experience","volume":"46","author":"Ilenghoven","year":"2020","journal-title":"Burns"},{"key":"2025081711173120000_6.1.e000655.11","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.20.00775","article-title":"Impact of COVID-19 on orthopaedic and trauma service: an epidemiological study","volume":"102","author":"Wong","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2025081711173120000_6.1.e000655.12","doi-asserted-by":"crossref","first-page":"698-703","DOI":"10.1016\/j.bjoms.2020.05.020","article-title":"Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study","volume":"58","author":"Blackhall","year":"2020","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2025081711173120000_6.1.e000655.13","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.injury.2020.06.006","article-title":"The evolving COVID-19 effect on hip fracture patients","volume":"51","author":"Hadfield","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.14","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.bjoms.2020.03.024","article-title":"Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic","volume":"58","author":"Holmes","year":"2020","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2025081711173120000_6.1.e000655.15","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.jcot.2020.05.010","article-title":"Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic","volume":"11","author":"Iyengar","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"2025081711173120000_6.1.e000655.16","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1080\/17453674.2020.1783621","article-title":"Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the \"golden month\"","volume":"91","author":"Park","year":"2020","journal-title":"Acta Orthop"},{"key":"2025081711173120000_6.1.e000655.17","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/s00264-020-04635-5","article-title":"Operational strategies of a trauma hub in early coronavirus disease 2019 pandemic","volume":"44","author":"Casiraghi","year":"2020","journal-title":"Int Orthop"},{"key":"2025081711173120000_6.1.e000655.18","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.20.00756","article-title":"Impact of the COVID-19 pandemic on orthopaedic and trauma surgery in university hospitals in Germany: results of a nationwide survey","volume":"102","author":"Haffer","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2025081711173120000_6.1.e000655.19","first-page":"1","article-title":"Indirect effects of the COVID19 pandemic in patients requiring neurosurgical care: will the second wave carry more severe neurosurgical patients?","author":"Joubert","year":"2020","journal-title":"Br J Neurosurg"},{"key":"2025081711173120000_6.1.e000655.20","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/j.injury.2020.05.015","article-title":"\"Flattening the curve\" of COVID-19 pandemic in orthopaedics and trauma: the Greek perspective","volume":"51","author":"Kenanidis","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.21","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.medcli.2020.05.016","article-title":"[Musculoskeletal injuries secondary to exercise during confinement by the pandemic COVID-19]","volume":"155","author":"Lopez Martinez","year":"2020","journal-title":"Med Clin"},{"key":"2025081711173120000_6.1.e000655.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.05.016"},{"key":"2025081711173120000_6.1.e000655.23","doi-asserted-by":"crossref","first-page":"946","DOI":"10.2106\/JBJS.20.00454","article-title":"Preparing to perform trauma and orthopaedic surgery on patients with COVID-19","volume":"102","author":"Rodrigues-Pinto","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2025081711173120000_6.1.e000655.24","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.injury.2020.05.041","article-title":"Trauma care in a low-COVID pandemic environment: a new normal","volume":"51","author":"Joseph","year":"2020","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.25","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.burns.2020.04.003","article-title":"Burn center function during the COVID-19 pandemic: an international multi-center report of strategy and experience","volume":"46","author":"Barret","year":"2020","journal-title":"Burns"},{"key":"2025081711173120000_6.1.e000655.26","doi-asserted-by":"crossref","first-page":"E173","DOI":"10.1093\/neuros\/nyaa146","article-title":"Letter: adaptation under fire: two Harvard neurosurgical services during the COVID-19 pandemic","volume":"87","author":"Arnaout","year":"2020","journal-title":"Neurosurgery"},{"key":"2025081711173120000_6.1.e000655.27","doi-asserted-by":"crossref","first-page":"100423","DOI":"10.1016\/j.eclinm.2020.100423","article-title":"When pandemics clash: gendered violence-related traumatic brain injuries in women since COVID-19","volume":"24","author":"Valera","year":"2020","journal-title":"EClinicalMedicine"},{"key":"2025081711173120000_6.1.e000655.28","doi-asserted-by":"crossref","DOI":"10.1177\/1759720X20934276","article-title":"Impact of COVID-19 on orthopaedic care: a call for nonoperative management","volume":"12","author":"Phillips","year":"2020","journal-title":"Ther Adv Musculoskelet Dis"},{"key":"2025081711173120000_6.1.e000655.29","doi-asserted-by":"crossref","first-page":"e336","DOI":"10.1097\/BOT.0000000000001860","article-title":"Effect of Shelter-in-Place orders and the COVID-19 pandemic on orthopaedic trauma at a community level II trauma center","volume":"34","author":"Stoker","year":"2020","journal-title":"J Orthop Trauma"},{"key":"2025081711173120000_6.1.e000655.30","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.injury.2016.04.002","article-title":"Traumatic injury in the United States: in-patient epidemiology 2000-2011","volume":"47","author":"DiMaggio","year":"2016","journal-title":"Injury"},{"key":"2025081711173120000_6.1.e000655.31","unstructured":"Centers for Disease Control and Prevention . Cases in the US USA: CDC. 2020. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/cases-updates\/cases-in-us.html (29 Jul 2020)."},{"key":"2025081711173120000_6.1.e000655.32","unstructured":"Shilling F , Waetjen D . Special report: impact of COVID19 on California traffic accidents, 2020."},{"key":"2025081711173120000_6.1.e000655.33","doi-asserted-by":"crossref","DOI":"10.2196\/19369","article-title":"Collateral crises of gun preparation and the COVID-19 pandemic: Infodemiology study","volume":"6","author":"Caputi","year":"2020","journal-title":"JMIR Public Health Surveill"},{"key":"2025081711173120000_6.1.e000655.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m1712","article-title":"Violence against women during covid-19 pandemic restrictions","volume":"28","author":"Roesch","year":"2020","journal-title":"BMJ"},{"key":"2025081711173120000_6.1.e000655.35","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.amsu.2020.07.003","article-title":"A scoping review of the impact of COVID-19 pandemic on surgical practice","volume":"57","author":"Soltany","year":"2020","journal-title":"Ann Med Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2020-000655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:17:43Z","timestamp":1755454663000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2020-000655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,4,2]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/tsaco-2020-000655"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2020-000655","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}