Increased Lengths of Stay, ICU, and Ventilator Days in Trauma Patients with Asymptomatic COVID-19 Infection

Abstract

Background

The SARS-Cov-2 coronavirus has varying clinical effects—from asymptomatic patients to life-threatening illness and death. At the only Level 1 Trauma Center in a rural state, outcomes appeared worse in trauma patients who tested positive for COVID despite these patients presumably being asymptomatic or only mildly affected before their traumatic event. This study compares all trauma admissions that were COVID-positive to those who were not.

Methods

The institutional database was queried for all level 1 and 2 trauma activations from March 2020-July 2021. The analysis consisted of a multivariate regression between COVID-negative and the COVID-positive group controlling for age, injury severity score (ISS), and Glasgow Coma Score (GCS). Outcomes compared were hospital length-of-stay (LOS), ICU LOS, ventilator days, days to discharge to a facility, and in-hospital mortality.

Results

Hospital LOS was 2.7 days longer in the COVID-positive group ( P < .0005). ICU LOS was 2.9 days longer for patients admitted to the ICU in the COVID positive-group ( P = .017). Ventilator days were 4.7 days longer for patients requiring mechanical ventilation in the COVID-positive group ( P = .002). Discharge to a post-acute facility required 6.1 more days in the COVID-positive group ( P = .005).

Conclusion

Trauma patients presenting positive for COVID-19 are presumed to be asymptomatic before their traumatic event. Despite this, the physiologic toll of trauma combined with the COVID infection causes significantly worse clinical outcomes, including increasing hospital days in this patient population, which continues to tax the already burdened healthcare system.