University of Wisconsin–Madison Medical College of Wisconsin

A Milwaukee Syndemic? Penetrative Injury and COVID-19

Alexandra Dove, BS; Kara J. Kallies, MS; Stephen Hargarten, MD, MPH; Carissa W. Tomas, PhD

WMJ. 2023;122(5):313-318

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Introduction: This study sought to evaluate injury frequency of penetrative trauma before and after stay-at-home orders were implemented due to COVID-19 in Wisconsin.

Methods: Patients who presented to a level I trauma center from January 2018 through December 2021 with a mechanism of injury of firearm or stab wound were included. The study was split into pre-COVID (January 2018-February 2020) and COVID (March 2020-December 2021) periods. Statistical analysis included chi-square tests and interrupted time series analysis.

Results: A total of 1702 patients met inclusion criteria. The COVID group had a statistically significantly higher proportion of firearm injuries (83.2%) and a significantly lower proportion of stab injuries (16.8%) compared to the pre-COVID period group (70% and 30%, respectively, P < 0.001). There was no change from pre-COVID to COVID periods in in-hospital mortality or length of hospital stays. There was an increase in firearm incidents in the COVID period in 72% of Milwaukee County ZIP codes and a decrease in stab incidents in 48% of ZIP codes. Interrupted time series analysis indicated a significant increase from the pre-COVID to COVID periods in monthly firearm and stab injuries. Firearm injury significantly increased from pre-COVID to COVID for Black or African American patients but no other racial group.

Conclusions: These findings are consistent with other state and national trends suggesting increasing penetrative injury during the COVID-19 pandemic. The intersection of the COVID-19 pandemic and violence pandemic may yield a “syndemic,” imposing a significant burden on trauma systems. Evidenced-based public health interventions are needed to mitigate the surge of firearm injuries.

Author Affiliations: Medical College of Wisconsin School of Medicine, Milwaukee, Wisconsin (Dove); Institute for Health and Equity, MCW, Milwaukee, Wis (Kallies, Tomas); Department of Emergency Medicine, MCW, Milwaukee, Wis (Hargarten); Comprehensive Injury Center, MCW, Milwaukee, Wis (Hargarten, Tomas).
Corresponding Author: Alexandra Dove, BS, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226; email; ORCID ID 0000-0002-0841-2347
Funding/Support: This study was supported by an internal grant from the Medical College of Wisconsin Department of Emergency Medicine.
Financial Disclosures: None declared.
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