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Trends in Violent Penetrating Injuries During the First Year of the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Was the COVID-19 pandemic associated with differences in levels, timing, and types of violent penetrating injuries presenting to a level I urban trauma center?

Findings  In this cross-sectional study that included 2383 patients with violent injuries, there was a significant increase in patients who presented with firearm injuries but not stabbing injuries during the first pandemic year compared with the previous 5 years. This surge in firearm injuries began while Massachusetts was still under a stay-at-home advisory and before large-scale racial justice protests.

Meaning  These findings suggest that policies and procedures aimed at mitigating firearm violence as part of all-hazard preparedness are warranted.


Importance  Public health measures instituted to reduce the spread of COVID-19 led to severe disruptions to the structure of daily life, and the resultant social and financial impact may have contributed to an increase in violence.

Objective  To examine the trends in violent penetrating injuries during the first COVID-19 pandemic year compared with previous years.

Design, Setting, and Participants  This retrospective cross-sectional study was performed to compare the prevalence of violent penetrating injuries during the first COVID-19 pandemic year, March 2020 to February 2021, with the previous 5 years, March 2015 to February 2020. This study was performed among all patients with a violent penetrating injury presenting at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. Data were analyzed from January 4 to November 29, 2021.

Main Outcomes and Measures  The primary outcomes were the incidence and timing of emergency department presentation for violent penetrating injuries during the first year of the COVID-19 pandemic compared with the previous 5 years. Patient demographics and injury characteristics were also assessed.

Results  A total of 2383 patients (median [IQR] age, 29.5 [23.4-39.3] years; 2032 [85.4%] men and 351 [14.6%] women) presenting for a violent penetrating injury were evaluated, including 1567 Black patients (65.7%), 448 Hispanic patients (18.8%), and 210 White patients (8.8%). There was an increase in injuries during the first pandemic year compared with the previous 5 years, with an increase in shootings (mean [SD], 0.61 [0.89] injuries per day vs 0.46 [0.76] injuries per day; P = .002) but not stabbings (mean [SD], 0.60 [0.79] injuries per day vs 0.60 [0.82] injuries per day; P = .78). This surge in firearm violence began while Massachusetts was still under a stay-at-home advisory and before large-scale racial justice protests began. Patients presenting with violent penetrating injuries in the pandemic surge months (April-October 2020) compared with the same period in previous years were disproportionately male (153 patients [93.3%] vs 510 patients [87.6%]; P = .04), unemployed (70 patients [57.4%] vs 221 patients [46.6%]; P = .03), and Hispanic (40 patients [26.0%] vs 99 patients [17.9%]; P = .009), with a concurrent decrease in White patients (0 patients vs 26 patients [4.7%]), and were more likely to have no previous history of violent penetrating injury (146 patients [89.0%] vs 471 patients [80.9%]; P = .02).

Conclusions and Relevance  These findings suggest that unprecedented measures implemented to mitigate the spread of COVID-19 were associated with an increase in gun violence. As the pandemic abates, efforts at community violence prevention and intervention must be redoubled to defend communities against the epidemic of violence.

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Article Information

Accepted for Publication: December 3, 2021.

Published: February 8, 2022. doi:10.1001/jamanetworkopen.2021.45708

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Pino EC et al. JAMA Network Open.

Corresponding Author: Elizabeth C. Pino, PhD, Boston Violence Intervention Advocacy Program (VIAP), Department of Emergency Medicine, Boston Medical Center, 800 Harrison Ave, BCD Building 4009Q, Boston, MA 02118 (elizabeth.pino@bmc.org).

Author Contributions: Dr Pino had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Pino, Gebo, Jay.

Drafting of the manuscript: Pino, Dugan.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Pino, Gebo.

Administrative, technical, or material support: Pino, Dugan.

Supervision: Pino, Dugan.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the Department of Emergency Medicine, Boston Medical Center, and the Boston University Clinical and Translational Science Institute (grant No. 1UL1TR001430).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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