背景:外伤时COVID-19感染的影响仍未得到充分研究。先前的研究表明,创伤患者的COVID-19疫苗接种率仍然低于普通人群。本研究旨在了解伴随COVID-19感染对创伤患者预后的影响。
方法:我们对2020年3月至2022年12月入住I级创伤中心的≥18岁患者进行了回顾性队列研究。包括使用快速抗原/PCR测试进行COVID-19感染测试的患者。我们使用2:1的年龄倾向匹配患者,性别,种族,合并症,疫苗接种状况,损伤严重程度评分(ISS),损伤的类型和机制,和GCS在抵达。主要结果是住院患者死亡率。次要结果包括住院时间(LOS),重症监护病房(ICU)LOS,重新接纳30天,和主要并发症。
结果:在包括的4448例患者中,168(3.8%)为阳性(COV)。与COVID-19阴性(COV-)患者相比,COV+患者年龄相似,性别,BMI,ISS,损伤类型,区域AIS。在COV患者中,白人和非西班牙裔患者的比例较高。匹配后,确定了154例COV+和308例COV-患者。COVID-19阳性患者的死亡率更高(7.8%vs2.6%;P=.010),主要并发症(15.6%vs8.4%;P=0.020),和血栓性并发症(3.9%vs.6%;P=.012)。患者的住院LOS也更长(中位数,9天vs5天;P<.001)和ICULOS(中位数,5天vs3天;P=.025)。
结论:合并COVID-19感染的创伤患者在匹配人群中具有更高的死亡率和发病率。应采取重点干预措施,以识别这一高危人群并预防其内部的COVID-19感染。
BACKGROUND: The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients.
METHODS: We conducted a retrospective cohort study of patients ≥18 years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications.
RESULTS: Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; P = .010), major complications (15.6% vs 8.4%; P = .020), and thrombotic complications (3.9% vs .6%; P = .012). Patients also had a longer hospital LOS (median, 9 vs 5 days; P < .001) and ICU LOS (median, 5 vs 3 days; P = .025).
CONCLUSIONS: Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.