This multicenter study examined the impact of the SARS-CoV-2 pandemic on common risk factors and treatment management for patients suffering from chest trauma. According to the present findings, we found no significant difference in the baseline patient characteristics between the two groups. Chest trauma combined with COVID-19 was associated with a higher total 30-day mortality. Chest trauma associated with COVID-19 also aggravated hospital stays and hospitalization costs. Additionally, COVID-19 combined with chest trauma increases complications during hospitalization, such as pneumonia, pulmonary embolism, 7-day delirium, respiratory failure, heart failure, and MODS.

Globally, the COVID-19 pandemic has impacted healthcare systems and practitioners. In December, COVID-19 spread in China after ending the zero-COVID policy. In the first month, almost all hospitalized patients were infected with COVID-19 before hospitalization or after admission. Overall, we did not find any differences between chest trauma combined with COVID-19 infection or not on baseline characteristics, such as age, sex, cause of disease, past medical history, and flail chest. We found that chest trauma combined with COVID-19 may result in a worse clinical outcome, more complications, and significantly increased chest trauma patients’ hospital stays and hospitalization costs. Patients with chest trauma often have lung infections. However, infection with COVID-19 can worsen lung infections, greatly increasing the rate of respiratory failure, and leading to longer hospital stays and larger hospitalization costs. Additionally, COVID-19 is often accompanied by fever and drug factors combined with gastrointestinal symptoms (diarrhea, poor appetite, etc.), resulting in increased water loss, and blood concentration is one of the risk factors for VTE. The use of a large number of hormones and immunoglobulins also causes blood stasis and aggravates the formation of VTE. A previous study reported that the levels of hypercoagulability indices, such as D-dimer, fibrinogen, and factor VIII, increased in all COVID-19 patients [9]. Recent research findings also reported that microvascular thrombi, neutrophil-platelet aggregates, endothelial inflammation, acquired antiphospholipid antibodies, hypercoagulability related to elevated coagulation factor levels, and reduced levels of endogenous anticoagulant proteins were potential mechanisms by which VTE occurs [10,11,12]. Hence, early anticoagulant therapy was necessary. To our knowledge, this was the first study to explore the clinical characteristics and outcomes of chest trauma patients during the COVID-19 pandemic.

Tilliridou et al. [13] reported that the 30-day mortality rate was higher in COVID-19 patients with pulmonary embolism than in those without pulmonary embolism. Multiple traumas combined with COVID-19 infection and positive CT findings can increase the risk for pulmonary complications [14]. Driessen et al. [15] also reported that there was a higher mortality rate during the SARS-CoV-2 pandemic than before. In the present study, we also found that more patients who died from chest trauma were infected with COVID-19, and the leading cause of death was multiple organ failure due to severe lung infection.

This study also had some limitations. First, the sample size was small, and larger sample studies are needed to explore the impact of the SARS-CoV-2 pandemic on the common risk factors and treatment management for patients suffering from chest trauma. Second, since we conducted a cross-sectional and retrospective study, we cannot demonstrate causality based on the data retrieved, and future studies examining the impact of a pandemic on intentional chest trauma should adopt a prospective, longitudinal design to allow the identification of risk factors and examination of causal links between variables. Third, the present study addresses only the short-term adverse events and efficacy of COVID-19 infection in chest trauma patients, and a long-term result is needed. Another limitation is related to missing data in the medical record database, including detailed clinical characteristics of chest trauma, such as the severity of injury and operation. Therefore, further and larger populations of chest trauma patients with COVID-19 should be investigated.