The volume of trauma CT scans fluctuated when compared to pre-COVID data, COVID-19 social-distancing orders, and the post-pandemic period — according to researchers at the University of California, Irvine, in a study published online in Emergency Radiology. The study was led by radiologist Roozbeh Houshyar, MD, and his colleagues. They followed CT trauma volume at UC-Irvine Medical Center before, during, and after COVID pandemic restrictions on crowds were in place.
The research team discovered that when social-distancing mandates were relaxed, trauma visits to the ER rose by 35% above the pre-pandemic level. The number of daily trauma CT scans rose by 17%, but the number of CT scans per patient dropped. They also discovered that the time from exam order to scan completion increased considerably — from 31 minutes to 47 minutes.
Study Details
Houshyar’s team examined patient characteristics, CT imaging volumes, and turnaround times for each adult emergency department trauma patient who required CT imaging at their Level-I trauma center. It is located in Orange County, CA, the 6th most populous county in the United States. The study group was comprised of trauma patients from 1/2018 through 2/2022. A total of 16,984 trauma patients fell into the study time frame, which was divided into 3 groups:
| Baseline | COVID | Post-COVID |
| 1/1/2018 – 3/19/2020 | 3/20/2020 – 1/25/2021 | 1/26/2021 – 2/28/22 |
| 8,289 trauma patients | 3,139 trauma patients | 5,556 trauma patients |
| 48.3 per day | 47.6 per day | 56.7 per day |
Decreases in emergency department trauma visits were seen during the two-week “shelter-in-place” order throughout the U.S. — California trauma imaging decreased by about 30% during that time frame.
The University of California, Irving researchers suspect that the increase in completion times was most probably due to a combination of circumstances, including decreased staffing, imaging equipment utilization, equipment downtime, and the general stress created by more critically ill patients diagnosed with COVID. The researchers commented,
“Although we are not aware of any adverse events specifically related to delayed CT examination, timely completion of trauma CT examinations is an essential
component of appropriate triage and optimal care. In addition, imaging of trauma
patients can delay evaluation of other ED patients awaiting CT examinations,
as trauma patients essentially “skip the line” of patients waiting to be imaged.
As trauma cases increased in the POST period, there may have been delays in CT turnaround time for non-trauma emergency department patients, which merits further research.”
Troubling Trauma Details Emerge
The study saw a 32% increase in motor vehicle collisions, which may correspond with other studies that showed a rise in risky driving behaviors — driving under the influence of alcohol, speeding, and failure to wear seatbelts — in 2020.
Houshyar and his researchers discovered a troubling trend during the post-COVID period. The rate of both assaults and overall penetrating trauma each increased by 44% when compared to the baseline, pre-pandemic period. Researchers noted that this increase coincides with the rise in firearm sales during the COVID-pandemic period.
The researchers note, “Although COVID safety measures during the study period represent an important societal event, we did not control for additional variables which may have had an impact, including other societal factors, seasonality, or longer-term trends in trauma volumes and mechanisms . . . These findings suggest that additional resources, innovative approaches, and further research are necessary to effectively provide emergent imaging for an increasing trauma population.”