To compare pre-admission emergency department (ED) mortality among patients with head or neck open wounds as the primary diagnosis before and during the COVID-19 pandemic and describe variation across patient and hospital characteristics.

This retrospective, repeated cross-sectional analysis used nationally weighted estimates from the Nationwide Emergency Department Sample obtained through HCUPnet for 2017–2022. Initial ED encounters for CCSR INJ011 were grouped into pre-pandemic (2017–2019) and pandemic (2020–2022) periods. Pre-admission ED mortality, defined as death in the ED before inpatient admission, was calculated per 100,000 eligible visits. Crude differences across groups, along with odds ratios (ORs) and relative percent change (RPC) were reported overall and by patient and hospital characteristics.

Eligible visits decreased from 5915,923 to 5350,734, whereas pre-admission ED deaths increased from 6193 to 6934. Pre-admission ED mortality increased from 104.68 to 129.59 per 100,000 eligible ED encounters (Difference: +24.91; RPC: +23.79%; OR: 1.24). Increases occurred across most examined strata, with numerical variations across race and ethnicity, age, payer, patient residence, hospital rurality, trauma status, and ownership.

Pre-admission ED mortality among encounters for head and neck open wounds was higher during 2020–2022 than during 2017–2019 despite fewer eligible visits. Because analyses were unadjusted and lacked injury severity, mechanism, and prehospital data, findings are descriptive and may reflect changes in case mix and prehospital conditions. Nevertheless, we identify patient and institutional groups for adjusted investigation leading to emergency-care surge planning.