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Manasa M, Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Tay-Lasso E, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. Am Surg 2023; 89:6053-6059. [PMID: 37347234 DOI: 10.1177/00031348221124329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS. METHODS A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed. RESULTS 5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001). CONCLUSION This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.
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Affiliation(s)
- Morgan Manasa
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Riverside University Health System, Moreno Valley, CA, USA
| | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | | | - Erika Tay-Lasso
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
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Boldea GJ, Caragea DC, Nicolcescu P, Pădureanu V, Rădulescu D, Boldea AM, Georgescu I, Georgescu EF. Effect of the COVID‑19 pandemic on the management and outcomes of patients with traumatic injuries (Review). Biomed Rep 2023; 19:76. [PMID: 37746590 PMCID: PMC10511947 DOI: 10.3892/br.2023.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
During the COVID-19 pandemic, ~10% of the global population was officially affected, resulting in diverse changes, ranging from shopping habits to stringent hospital protocols. This article sought to provide a concise summary of relevant data concerning the interplay between COVID-19 and trauma, encompassing the entire trajectory from presentation to hospital discharge. Throughout the pandemic, there was a noticeable reduction in trauma presentations, while the ranking of injury mechanisms remained largely unchanged. To ensure essential surgical support, protocols were adjusted accordingly. Although there were some less significant changes in injury severity score, hospital length of stay, intensive care unit stay and mortality, the overall patient outcomes appeared to improve. In conclusion, the COVID-19 pandemic led to a decline in trauma cases and an enhancement in patient outcomes. However, regrettably, certain mechanisms of injury saw an increase in frequency. To cope with the epidemiological context, management strategies were adapted, and unutilized resources were redirected to cater to the care of COVID-19 patients.
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Affiliation(s)
- Gheorghe-Jean Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Pantelie Nicolcescu
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Sibiu 550169, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dumitru Rădulescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ana Maria Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ion Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Eugen Florin Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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Adekunle AD, Rubens M, Sedarous M, Tariq T, Okafor PN. Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic. World J Gastroenterol 2023; 29:744-757. [PMID: 36742171 PMCID: PMC9896617 DOI: 10.3748/wjg.v29.i4.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/05/2022] [Accepted: 11/29/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The impact of the coronavirus on hospitalizations for gastrointestinal (GI) disease, particularly at a population level is understudied.
AIM To investigate trends in hospitalizations, inpatient endoscopy resource utilization, and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.
METHODS Using the California State Inpatient Database for 2018-2020, we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality (all-cause & viral pneumonia-specific) for common inpatient GI diagnoses including acute pancreatitis, diverticulitis, cholelithiasis, non-infectious gastroenteritis, upper and lower GI bleeding (LGIB), Clostridium difficile, viral gastroenteritis, inflammatory bowel disease, and acute cholangitis.
RESULTS Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding (NVUGIB), LGIB, and ulcerative colitis (UC) (ptrend < 0.0001). All-cause inpatient mortality was higher in 2020 vs 2019, for acute pancreatitis (P = 0.029), diverticulitis (P = 0.04), NVUGIB (P = 0.003), and Crohn’s disease (P = 0.004). In 2020, hospitalization rates were lowest in April, November, and December. There was no significant corresponding increase in inpatient mortality except in UC (ptrend = 0.048). Viral pneumonia and viral pneumonia complicated by respiratory failure increased (P < 0.001) among GI hospitalizations. Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB (P < 0.001).
CONCLUSION Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic, particularly in April, November and December 2020. All-cause mortality was significantly higher among acute pancreatitis, diverticulitis, NVUGIB, and Crohn’s disease hospitalizations. Emergency endoscopy rates were mostly comparable between 2020 and 2019.
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Affiliation(s)
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Miami, FL 33176, United States
| | - Mary Sedarous
- Division of Internal Medicine, McMaster University, Hamilton ON L8S 4L8, Ontario, Canada
| | - Tahniyat Tariq
- Division of Gastroenterology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Philip N Okafor
- Division of Gastroenterology, Stanford University College of Medicine, Redwood City, CA 94063, United States
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Banks KC, Mooney CM, Borthwell R, Victorino K, Coutu S, Mazzolini K, Dzubnar J, Browder TD, Victorino GP. Racial Disparities Among Trauma Patients During the COVID-19 Pandemic. J Surg Res 2023; 281:89-96. [PMID: 36137357 PMCID: PMC9420714 DOI: 10.1016/j.jss.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Given the disparate effects of the COVID-19 pandemic on people of color, we hypothesized that patients of color experienced a disproportionate increase in trauma during the COVID-19 pandemic. MATERIALS AND METHODS We compared trauma patients arriving in the 3 y before our statewide stay-at-home mandate on March 20, 2020 (PRE) to those arriving in the year afterward (POST). In addition to race/ethnicity, we assessed patient demographics and other clinical variables. Chi-squared, Fisher's exact, and Mann-Whitney U tests were used for univariate analyses. A multivariable logistic regression was performed to assess for associations with mortality. RESULTS During the study period, 8583 patients were included in the PRE group and 2883 were included in the POST group. There were increases in penetrating trauma (PRE 14.7%, POST 23.1%; P < 0.001) and mortality rates (PRE 3.20%, POST 4.60%; P < 0.001). From PRE to POST, the percentage of Black patients increased from 35.0% to 38.3% (P = 0.01) and the percentage of Hispanic patients increased from 19.2% to 23.0% (P < 0.001). After a multivariable analysis, Asian patients experienced an independent increase in mortality from PRE to POST (odds ratio 2.00, 95% confidence interval 1.13-3.54, P = 0.02). CONCLUSIONS Penetrating trauma and mortality rates increased during the pandemic. There was a simultaneous increase in the percentage of Black and Hispanic trauma patients. Asian patient mortality increased significantly after the start of the pandemic independent of other variables. Identifying racial/ethnic disparities is the first step in finding ways to improve dissimilar outcomes.
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Affiliation(s)
- Kian C Banks
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
| | - Colin M Mooney
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Rachel Borthwell
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kealia Victorino
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Sophia Coutu
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Kirea Mazzolini
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Jessica Dzubnar
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Timothy D Browder
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
| | - Gregory P Victorino
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, California
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Ruhi-Williams P, Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else? Am Surg 2022; 88:2429-2435. [PMID: 35583103 PMCID: PMC9127450 DOI: 10.1177/00031348221101475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social
interactions affect development. This has the potential to change adolescent
trauma. A post-hoc multicenter retrospective analysis of adolescent
(13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed.
Patients were divided into 3 groups based on injury date: historical control
(CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH
(POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL
groups in separate analyses. 726 ATPs were identified across the 3
time periods. POST had a similar penetrating trauma rate compared to both PRE
(15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%,
P = .69). POST also had a similar rate of suicide attempts
compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2%
vs 2.1%, P = .43). However, POST had a higher rate of drug
positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but
was similar in all other comparisons of alcohol and drugs to PRE and POST
periods (all P > .05). Hence ATPs were affected differently
than adults and children, as they had a similar rate of penetrating trauma,
suicide attempts, and alcohol positivity after SAH orders. However, they had
increased drug positivity compared to the CONTROL, but not PRE group.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA.,Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA.,472028Riverside University Health System Medical CenterUniversity, Moreno Valley, CA, USA
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, 21380Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Justine Chinn
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
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Emigh B, Clark DH, Schellenberg M. The impact of coronavirus 2019 on trauma. Curr Opin Anaesthesiol 2022; 35:154-159. [PMID: 35045003 DOI: 10.1097/aco.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The relationship between trauma and the ongoing global coronavirus 2019 (COVID-19) pandemic is still largely unclear. This comprehensive review of recent studies examining overall trauma volumes, mechanisms of injury, and outcomes after trauma during the COVID-19 pandemic was performed to better understand the impact of the pandemic on trauma patients. RECENT FINDINGS In the early stages of the pandemic, the overall volumes of patients seen in many major trauma centers had decreased; however, these rates largely returned to historical baselines after the cessation of stay-at-home orders. An increasing proportion of trauma patients were injured by penetrating mechanisms during the pandemic. Being a victim of interpersonal violence was an independent risk factor for COVID-19 infection. In two studies utilizing propensity score-matched analysis among trauma patients, COVID-19 infection was associated with a five- to sixfold increase in mortality risk as compared to uninfected patients. SUMMARY Consequences of the COVID-19 pandemic include increased financial stressors, job loss, mental illness, and illegal drug use, all of which are known risk factors for trauma. This is particularly true among vulnerable patient populations such as racial minority groups and low socioeconomic status patients. To lessen the impact of COVID-19 on trauma patients, increased awareness of the problem and heightened emphasis on injury prevention must be made.
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Affiliation(s)
- Brent Emigh
- Division of Acute Care Surgery, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
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Abstract
PURPOSE The COVID-19 pandemic resulted in increased penetrating trauma and decreased length of stay (LOS) amongst the adult trauma population, findings important for resource allocation. Studies regarding the pediatric trauma population are sparse and mostly single-center. This multicenter study examined pediatric trauma patients, hypothesizing increased penetrating trauma and decreased LOS after the 3/19/2020 stay-at-home (SAH) orders. METHODS A multicenter retrospective analysis of trauma patients ≤ 17 years old presenting to 11 centers in California was performed. Demographic data, injury characteristics, and outcomes were collected. Patients were divided into three groups based on injury date: 3/19/2019-6/30/2019 (CONTROL), 1/1/2020-3/18/2020 (PRE), 3/19/2020-6/30/2020 (POST). POST was compared to PRE and CONTROL in separate analyses. RESULTS 1677 patients were identified across all time periods (CONTROL: 631, PRE: 479, POST: 567). POST penetrating trauma rates were not significantly different compared to both PRE (11.3 vs. 9.0%, p = 0.219) and CONTROL (11.3 vs. 8.2%, p = 0.075), respectively. POST had a shorter mean LOS compared to PRE (2.4 vs. 3.3 days, p = 0.002) and CONTROL (2.4 vs. 3.4 days, p = 0.002). POST was also not significantly different than either group regarding intensive care unit (ICU) LOS, ventilator days, and mortality (all p > 0.05). CONCLUSIONS This multicenter retrospective study demonstrated no difference in penetrating trauma rates among pediatric patients after SAH orders but did identify a shorter LOS.
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