IMPACT OF THE COVID-19 PANDEMIC ON THE SEVERITY AND OUTCOMES OF GUNSHOT INJURIES.

Abstract

Objective: To evaluate the impact of COVID-19 infection on injury severity, clinical course, complications, and hospital outcomes in patients with gunshot injuries.

Materials and methods: This retrospective descriptive-analytical study was conducted at the Central Clinical Military Hospital of the Ministry of Defence of the Republic of Armenia. The study included 80 male patients with gunshot injuries who were hospitalized during 2020. Of these, 55 (68.8%) patients were COVID-19-positive and 25 (31.2%) were COVID-19-negative. Injury severity was assessed using the Injury Severity Score (ISS) and the Glasgow Coma Scale (GCS). The rates of intensive care unit (ICU) admission, requirement for mechanical ventilation, length of hospital stay, complications, and in-hospital mortality were analyzed.

Results: The mean ISS was significantly higher in COVID-19-positive patients than in COVID-19-negative patients (22.8±7.4 vs. 15.2±5.8, p<0.01). Conversely, the mean GCS score was significantly lower in the COVID-19-positive group (12.9±2.5 vs. 14.6±1.8, p<0.05). ICU admission was required in 43.6% of COVID-19-positive patients compared with 16.0% of COVID-19-negative patients. Mechanical ventilation was required in 21.8% and 8.0% of patients, respectively. The incidence of complications was 29.1% in the COVID-19-positive group and 12.0% in the COVID-19-negative group. In-hospital mortality was 10.9% and 4.0%, respectively. Correlation analysis demonstrated a significant positive association between ISS and length of hospital stay (r=0.61, p<0.001), as well as between ISS and mortality (r=0.58, p<0.001).

Conclusion: COVID-19 infection in patients with gunshot injuries is associated with greater injury severity, an increased need for intensive care, a higher incidence of complications and mortality, and prolonged hospitalization. The coexistence of COVID-19 infection and gunshot trauma may be regarded as a mutually aggravating clinical condition that requires early diagnosis, intensive monitoring, and a multidisciplinary treatment approach.