Cellular Telephone Activity As a Predictor of Trauma Patient Volume in New England a study from the research consortium of New England centers for trauma (ReCONECT) study
*Pawan Mathew1, Reginald Alouidor2, Alia Aunchman3, Haytham Kaafarani4, Jane Keating5, Stephanie Lueckel6, Manuel Moutinho7, Kevin M. Schuster1
1. Surgery, Yale School of Medicine, Bridgeport, CT, United States. 2. Baystate Health, Springfield, MA, United States. 3. University of Vermont, Burlington, VT, United States. 4. Surgery, Massachussetts General Hospital, Boston, MA, United States. 5. Hartford Hospital, Hartford, CT, United States. 6. Brown University, Providence, RI, United States. 7. Saint Francis Hospital, Hartford, CT, United States.
Objective
We sought to understand whether cellular telephone activity in commercial spaces as a marker for population mobility would be associated with trauma admission volumes and therefore a potential surrogate for trauma center need. We took advantage of cellular telephone data made available during the COVID pandemic along with the large swings in population activity to investigate this possibility.
Design
Trauma registry data from six level I trauma centers (TC) in New England were used to identify the number and nature of daily trauma admissions (TA). from January 20th 2020 to August 24th 2021. Center setting ranged from rural to urban. The Device Exposure Index (DEX) is a standardized measure of daily cellular telephone interactions with other cellular telephones within a county. Median, standard deviation and range for daily values of the DEX and number of TA were calculated. Spearman's rank correlation was calculated for the first wave of Covid-19 from March 2020 to May 2020 and for June to December 2020. Center-specific Poisson models were created to control for seasonality.
Setting
Level I trauma centers in the New England region.
Patients
All trauma patients arriving from the field to one of seven New England trauma centers.
Interventions
None
Main Outcome Measure
Daily trauma patient arrivals
Results
During the study period daily TA ranged from 13 to 77 (Median 42) across all participating TCs and substantial between center differences in daily TA volumes were observed (TC 1 median 4 vs. TC 2 median 10, p<0.001). After declaration of a public health emergency (PHE) on March 10, 2020, both the county DEX and overall number of TA?s declined sharply (80.5% and 70.5% respectively), both reaching their lowest levels at the end of March. Daily TA recovered to PHE levels by July 2020, whereas the DEX recovered more slowly, reaching pre- PHE levels in Spring of 2021. The daily DEX index was moderately correlated with TA?s from March to May of 2020 for five centers serving unique catchment areas, Spearman?s rho: ranging from 0.22 to 0.47 (p<0.05). The sixth center where the catchment area overlaps with those of multiple level - I centers had much lower correlation rho = 0.06 (p=0.59) [Table 1]. After controlling for seasonality, DEX vs. TA relationships remained significant across the same five centers [Table 2].
Conclusions
County-level daily DEX scores correlated significantly with TC-specific numbers of daily TA at 5 of 6 TCs during the first three months after PHE declaration. From June 2020 onward, TA quickly recovered to pre-PHE levels while DEX scores recovered more slowly. Similarity in these larger and longer-term trends may allow for trauma system planning. Additional research is needed; however, use of cellular telephone activity and interactions may be a valuable adjunct for trauma system planning.
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