Social Determinants of Health in Patients With Penetrating Trauma Injuries Before and During the COVID-19 Pandemic

November 15, 2023 updated by: Amber Jones, Kern Medical Center

The Impact of Social Determinants of Health in a Cohort of Patients With Penetrating Trauma Injuries Before and During the COVID-19 Pandemic

Investigators report on the impact of the COVID-19 stay-at-home order concerning penetrating violence and its association within different socioeconomic regions within the county. The distribution and volume of violent offenses prior to the stay-at-home order was compared to during the stay-at-home order. This bears a crucial significance in our injury prevention and education efforts within our community.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Investigators hypothesized that the COVID-19 'Stay At Home" order contributed to an increase in the incidence of violent traumatic injuries, particularly in areas with lower socioeconomic status in Kern County, as measured by census data, which was previously shown to be true in other areas of America. Investigators conducted a retrospective analysis of injuries sustained before and during the pandemic and further explored the median income of the area of injury to determine if socioeconomic status was a determinant of violent crime incidence rates. This study aims to better understand the causality of the increase in crime, further analyze the results, and identify trends in future public health crises.

This retrospective cross-sectional minimal risk study utilized the Kern Medical's trauma registry to identify patients in Kern County who presented to the emergency department with a gunshot wound (GSW), stab wound, or assault between March 2019 and February 2021. All reported blunt injuries, motor vehicle incident-related injuries, suicide attempts, or unintentional injuries were excluded. Each case was categorized as pre-COVID (March 2019 - February 2020) or COVID (March 2020 - February 2021) and further subclassified based on the incident zip code. Kern County zip codes were combined into urban regions as NW (zip codes:93312, 93314), NE (93301, 93305, 93306, 93308), SW (93311, 93313), and SE (93304, 93307, 93309, 93241), with a separate category defined as rural (outside Bakersfield city limits). These regions were also defined by median income as lower income (≤$50k: NW and SW) and higher income (>$50k: NE, SE, Rural) based on California census data. This study was approved by the Institutional Review board of Kern Medical Hospital.

Tabulated data were analyzed using odds ratios, chi-square tests of Independence, Woolf's test for homogeneity of Odds Ratios, Fisher's exact test, and the Generalized Cochran-Mantel-Haenszel test. Regions were identified with median incomes of ≤$50k and >$50K then were analyzed using a Cochran-Mantel-Haenszel test with an ad hoc analysis looking at the occurrence of GSWs and stab wounds pre-COVID and during COVID. A Bonferroni p-value adjustment was performed for all multiple comparison p-values. Additional demographic variables were collected, including patient demographics, follow-up, and death, but they were not included in these analyses.

Study Type

Observational

Enrollment (Actual)

803

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Bakersfield, California, United States, 93306
        • Kern Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patients in Kern County who presented to the emergency department with a gunshot wound (GSW), stab wound, or assault between March 2019 and February 2021. All reported blunt injuries, motor vehicle incident-related injuries, suicide attempts, or unintentional injuries were excluded. Each case was categorized as pre-COVID (March 2019 - February 2020) or COVID (March 2020 - February 2021) and further subclassified based on the incident zip code. Kern County zip codes were combined into urban regions as NW (zip codes:93312, 93314), NE (93301, 93305, 93306, 93308), SW (93311, 93313), and SE (93304, 93307, 93309, 93241), with a separate category defined as rural (outside Bakersfield city limits). These regions were also defined by median income as lower income (≤$50k: NW and SW) and higher income (>$50k: NE, SE, Rural) based on California census data.

Description

Inclusion Criteria:

  • emergency department presentation with a gunshot wound (GSW), stab wound, or assault between March 2019 and February 2021.

Exclusion Criteria:

  • All reported blunt injuries, motor vehicle incident-related injuries, suicide attempts, or unintentional injuries were excluded.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Pre-COVID
Patients identified in Kern County who presented to the emergency department with a gunshot wound (GSW), stab wound, or assault between March 2019 and February 2020 The group was further sub-classified based on the incident zip code. Kern County zip codes were combined into urban regions as NW (zip codes:93312, 93314), NE (93301, 93305, 93306, 93308), SW (93311, 93313), and SE (93304, 93307, 93309, 93241), with a separate category defined as rural (outside Bakersfield city limits).
COVID
Patients identified in Kern County who presented to the emergency department with a gunshot wound (GSW), stab wound, or assault between March 2020 - February 2021. The group was then further sub-classified based on the incident zip code. Kern County zip codes were combined into urban regions as NW (zip codes:93312, 93314), NE (93301, 93305, 93306, 93308), SW (93311, 93313), and SE (93304, 93307, 93309, 93241), with a separate category defined as rural (outside Bakersfield city limits).
Diagnostic test: Postive SAR-CoV-2 PCR nasopharyngeal swab
Diagnosed Covid-19 confirmed by a positive of SAR-CoV-2 PCR nasopharyngeal swab.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Penetrating injury rate
Time Frame: March 2019 - Februrary 2021
Penetrating injury rate including gunshot wounds, stab wounds or other penetrating assult
March 2019 - Februrary 2021

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Kern Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2019

Primary Completion (Actual)

February 1, 2021

Study Completion (Actual)

February 1, 2021

Study Registration Dates

First Submitted

November 14, 2023

First Submitted That Met QC Criteria

November 14, 2023

First Posted (Estimated)

November 16, 2023

Study Record Updates

Last Update Posted (Estimated)

November 17, 2023

Last Update Submitted That Met QC Criteria

November 15, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 0001143

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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