J.S. Roden-Foreman1, K. Weitzel1, S. Nobles1, S. Patidar1, K. Monday1 1Baylor University Medical Center, Department Of Surgery, Dallas, TX, USA
Introduction: Trauma remained a leading cause of death during the COVID-19 pandemic. Substance abusers are at higher risk of traumatic injuries, worse outcomes after trauma, and suffer from lack of access to care. During the pandemic, social isolation and lockdown measures have been projected to lead to worsening of substance and alcohol abuse. Additionally, patients with substance or alcohol abuse were at higher risk for contracting COVID-19 due this lack of access to care. While there is some evidence that previous pandemics were associated with an increased mental health burden, it is unclear whether this directly translated to increased traumatic injuries related to substance abuse. There is little data demonstrating whether these conditions led to increased substance users presenting with trauma during the recent pandemic.
Methods: A retrospective chart review was performed of patients presenting and admitted to a level 1 trauma center, and variables were extracted from the medical record and trauma database. Patients were included if they were evaluated by the trauma service in the ED. Patient characteristics including history of substance use including drugs, alcohol, and tobacco as well as urine drug screens during admission were aggregated by month and year as averages for comparison. Statistical significance was assessed with Kruskal Wallis tests then pairwise Mann-Whitney tests for significant (p < 0.05) global tests.
Results: Trauma patients with a history of alcohol use disorder accounted for 4.8 patients per 100 on average in 2019 but increased in 2020 to 11.9 per 100 and then decreased to pre-pandemic levels in 2021 to 4.5 per 100 [2019 vs 2020 (p=0.001), 2020 vs 2021 (p=0.001)]. Patients with a history of substance abuse accounted for 4.7 per 100 patients in 2019 but increased to 13 per 100 and 5.7 per 100 in 2020 and 2021, respectively [2019 vs. 2020 (p=0.001) and 2020 vs. 2021 (p=0.001)]. Patients with positive UDS were a higher percentage of patient in both pandemic years versus 2019. The highest percentage increases (>10% increase) from 2019 occurred in April, May, and September of 2020 and April and September of 2021.
Conclusion: Patients with a history of alcohol and substance abuse increased in the first year during the pandemic but began decreasing toward pre-pandemic levels in the second for patients presenting and admitted with trauma. Alcohol use as well as those with a history of substance use accounted for a larger proportion of the trauma population, likely secondary to increased social isolation and economic stresses due to the pandemic.