were due to acute falls associated with subsequent hypoxic brain injury . Although not statistically significant , all patients were over 65 years of age and had elevated coagulation studies , which includes prothrombin time ( PT ), partial thromboplastin time ( PTT ), and international normalized ratio ( INR ) calculation . This may highlight the effects COVID could instigate in a severe infection with concomitant DAMPs being released extracellularly post injury . 8-9 Stage of infection may also have played a critical factor in the fall victims ’ outcome , as it is known that the hypoxic stage IIb of COVID-19 infection decreases adequate oxygenation throughout the body . 10
Literature about the complications associated with COVID-19 in trauma patients in the US includes varied information . In our study , there were only increases in intubation rates , length of stay , and placement to hospice care . The aforementioned Kaufman et al . study noted increased complication rates , including intubation , unplanned ICU admissions , DVT and PE rates , and renal failure . 12 Yeats et al . had complication rates similar to our retrospective study with increased length of stay for COV + patients and no increased rate of ventilation or complications . However , they noted no changes in discharge disposition . 15 When comparing the outcomes of this study with the other two US studies , one must recognize the differences between each state . 12-15 Pennsylvania and California include multiple large cities that were devastated by the pandemic , whereas this cohort provides an outlook on a rural state that was less impacted by COVID-19 . 16 Moreover , each state has separate placement protocols for skilled nursing facilities , rehabilitation centers , and other healthcare centers throughout the pandemic , which could have affected hospital
17- 18 length of stay due to placement issues .
Our study has limitations . Firstly , this was a retrospective cohort study from a single center in a state that had a uniquely late entrance into the pandemic . The study could have been underpowered to detect true differences given the small sample size of 61 COV + patients . Multicenter data may eliminate this issue with a greater sample size of COV + patients and allow for results to be more generalized and possibly replicable throughout the region . Moreover , it can reduce biases from a specific hospital . Our data relied on the JMMTC trauma registry , which could have included misclassifications . The risk of misclassification could occur from data input errors in the registry . Due to the delay in reported COVID-19 cases in WV , Ruby Memorial Hospital had time to consolidate treatment plans globally . The use of monoclonal antibodies and dexamethasone to combat severe infection and its sequelae could have altered death rates in specific timelines . Furthermore , given that testing rates were at 59.3 %, there were likely undiagnosed infections . Lastly , we did not have access to the initial onset of COVID-19 symptoms pre-hospitalization , nor the severity of infection . Further studies should ideally include information about the severity of symptoms in COV + patients , along with data from all trauma centers in WV .
CONCLUSION
The findings of our study from a single center in WV include increased rates of length of stay and intubation rates with no increased rate of mortality or complications in COVID trauma patients compared to non-COVID trauma patients . Further research is needed to characterize the impact of COVID-19 for the entirety of the state .
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