• Debbie Y Madhok, Anthony Nardone, Elizabeth Urrutia Caceres, Angela H K Wong, Li Zhang, and Robert M Rodriguez.
• Department of Emergency Medicine; Department of Neurology.
• J Emerg Med. 2023 Dec 1; 65 (6): e479e486e479-e486.

BackgroundIn response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma.ObjectivesOur objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP.MethodsWe reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology.ResultsThere were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003).ConclusionsUnderstanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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