# Impact of SARS-CoV-2 Infection on the Outcomes of Trauma Patients at a Level I Trauma Center: An Ambispective Observational Study

## TL;DR

This study found that trauma patients with SARS-CoV-2 infection had worse outcomes, including longer hospital stays and more respiratory complications.

## Contribution

The study is the first ambispective observational analysis of trauma patient outcomes at a level I trauma center during the SARS-CoV-2 pandemic.

## Key findings

- SARS-CoV-2-positive trauma patients had longer intercostal drainage and hospital stays.
- These patients were more likely to develop ARDS and chest infections.
- Mortality was linked to SARS-CoV-2 infection despite lower injury severity scores.

## Abstract

Introduction: Trauma remained a leading cause of hospital admissions even during the COVID-19 pandemic. Trauma and surgical interventions are known to impair the patient’s immune function. Clinically, some asymptomatic COVID-19 patients experienced rapid deterioration following surgery. Surgeons and anesthesiologists need to be aware that acute lung injury caused by COVID-19 could be present preoperatively or may worsen postoperatively. Hence, an ambispective observational study was planned to assess the impact of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection on trauma patient outcomes.

Aims and objectives: This study aims to evaluate the impact of SARS-CoV-2 infection on the outcomes of trauma patients at a level I trauma center.

Materials and methods: This ambispective observational study was conducted at a level 1 trauma center and included patients admitted under the trauma surgery service in the COVID-19 facility. Their outcomes were compared with those of patients admitted to the non-COVID-19 facility from March 2020 to March 2022.

Results: A total of 2,017 patients were admitted under the Division of Trauma Surgery and Critical Care from March 2020 to March 2022. The mean duration of intercostal drainage (ICD) was significantly longer in SARS-CoV-2-positive trauma patients (7.03 ± 3.69 days) compared to SARS-CoV-2-negative trauma patients (5.28 ± 2.75). Acute respiratory distress syndrome (ARDS) was also more common among SARS-CoV-2-positive trauma patients. Additionally, these patients had a longer hospital stay. Notably, SARS-CoV-2-positive trauma patients who died had a significantly lower average injury severity score (ISS) compared to SARS-CoV-2-negative counterparts.

Discussion: Although the average ISS was lower and the average trauma and injury severity score (TRISS) was higher in SARS-CoV-2-positive trauma patients who died compared to SARS-CoV-2-negative trauma patients, overall mortality rates were comparable between the two groups.

Conclusion: Trauma patients with concomitant SARS-CoV-2 infection had a longer duration of ICD, along with an increased incidence of chest infections and ARDS. A greater proportion of SARS-CoV-2-positive trauma patients required ventilatory support. The mortality observed in SARS-CoV-2-positive trauma patients is likely attributed to the concomitant SARS-CoV-2 infection.