Louisville Medicine Volume 69, Issue 2 - Page 15

AUTHOR Brian Harbrecht , MD


AUTHOR Brian Harbrecht , MD

Calendar year 2020 brought several significant events that had not been experienced for decades . The major world event was the COVID-19 pandemic . All segments of society were affected by efforts to control and respond to COVID-19 and unprecedented changes occurred in how we interact with each other at work , school , in public and at home . For physicians , significant changes occurred in health care in all facets of the delivery of services , in both the hospital and the outpatient office . Remote work , telemedicine , “ contactless ” health care , shortages of supplies , shortages of personal protective equipment and reduced staffing levels were issues many providers had to confront . At the beginning of the pandemic , prioritization of essential services was required to prepare for the potential onslaught of COVID-19 patients to our facilities , to avoid the over-burdening of hospitals seen in many parts of the world . Cancellation of elective surgeries and reductions of office visits occurred early on until the magnitude of COVID-19 in our community could be determined . Unexpected limitations in the supply chain for important materials were uncovered . Many patients reportedly triaged themselves , avoiding physician offices and hospitals for fear of contracting COVID-19 from these settings although how often patients actually contracted COVID-19 from exposure in a health care setting was unclear . How many patients delayed medical visits and their own essential medical care may never be completely determined .

Despite the 2020 pandemic and restrictions on non-essential services , many patients continued to seek care for emergency conditions that could not wait . One such condition that frequently cannot be delayed , put off or ignored is traumatic injury . Trauma remains the leading cause of death for young adults less than 45 years of age and is the third leading cause of death for all ages in the US ( National Center for Injury Prevention and Control , webappa . cdc . gov ). This fact of life has not changed for decades and represents a public health problem that has persisted for a long time . Many health care experts speculated that stay-at-home orders , remote work arrangements and restricted travel associated with efforts to control the spread of COVID-19 would lead to a reduction in traumatic injury simply from fewer people getting out of their houses , being out on the road or exposed to hazardous situations . Reductions in motor vehicle crashes were seen in some communities such as San Francisco and Los Angeles . 2 , 3 The anticipated reduction in traumatic injury , however , did not materialize in our region .
Figure 1 shows that for 2020 , the number of patients admitted to University of Louisville Hospital , our community ’ s only Level 1 adult trauma center , increased 10 % compared to the prior years . Some experts speculated that more time at home and less time commuting to work or driving would shift injury patterns by reducing motorized vehicle crashes and increasing the frequency of falls . Falls are the leading mechanism of injury across the country according to data from the National Trauma Data Bank 1 and some communities saw an increase in falls associated with stay-at-home restrictions . 3 In our community , however , motor vehicle and motorcycle crashes have been the most common injury mechanism for injured patients admitted to ULH and this finding did not change during the COVID-19 pandemic ( Figure 2 ). Trauma physicians frequently use the Injury Severity Score ( ISS ) as one measure of injury severity . The ISS is an anatomic scale that attempts to quantify injury and it has been used to classify injuries as relatively minor injuries ( low ISS ) to serious or critical injuries ( high ISS ). As demonstrated in the Figure ( Figure 3 ), the distribution of ISS values for patients admitted in 2020 to ULH did not change compared to the years prior to the COVID-19 pandemic . Patients were not less severely injured despite the restrictions brought on by the pandemic . Certainly , the number of vehicles on the road during the COVID-19 pandemic appeared to be significantly decreased as any commuter during the usual Louisville morning and evening rush hours could attest . Whether there were fewer motor vehicle crashes in our area will need to be assessed using other data sources . It was clear , however , that there continued to be more injured patients presenting for care of their injuries in our community .
The year 2020 also showed a continued increase in our community in penetrating injuries ( Figure 3 ) that is largely driven by the increased number of shootings from gun violence . The steady rise of gun violence in Jefferson County has been widely publicized in the press and was not altered by the additional social pressures that were brought on or made worse by the COVID-19 pandemic . The
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