National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume

Arielle C. Thomas, Brendan T. Campbell, Haris Subacius, Claudia P. Orlas, Eileen Bulger, Ronald M. Stewart, Anne M. Stey, Angie Jang, Doulia Hamad, Karl Y. Bilimoria, Avery B. Nathens

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. Methods: All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. Results: There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).

Original languageEnglish (US)
Pages (from-to)3655-3662
Number of pages8
Issue number11
StatePublished - Nov 2022


  • COVID-19
  • Firearm violence
  • Interpersonal violence
  • Trauma epidemiology
  • Trauma systems

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine


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