1
|
Karmali S, Saxena S, Richards O, Thompson W, McFaull SR, Pike I. What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury. Front Public Health 2024; 12:1385452. [PMID: 38887259 PMCID: PMC11180821 DOI: 10.3389/fpubh.2024.1385452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. Objective A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Methods Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. Results The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Implications Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.
Collapse
Affiliation(s)
- Shazya Karmali
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | | | | | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Smith CS, Yoon L, Zuppke JN, Zundel M. Quantitative Analysis of Condition-based Limited Duty Duration of Musculoskeletal Conditions. Mil Med 2024:usae010. [PMID: 38330163 DOI: 10.1093/milmed/usae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Musculoskeletal injuries affect nearly a million service members annually within the DoD, ultimately costing the U.S. Military half a billion dollars in direct patient costs and a significant loss to fleet readiness as many members are assigned days on limited duty (LIMDU) until they are deemed medically fit to return to duty (RTD). The new approach implemented by Navy Medicine in 2022, called "condition-based LIMDU," aims to drastically impact the time in which Sailors and Marines spend under a provider's care by assigning LIMDU days based on a standardized set of guidelines. This study provides a quantitative analysis on LIMDU duration, before and after implementation of the new condition-based LIMDU paradigm, to increase the understanding on the effectiveness and impact to fleet readiness and to assess the accuracy of suggested patient outcome timelines. MATERIALS AND METHODS De-identified and aggregated data were obtained from the Naval Medical Forces Atlantic's (NMFL) LIMDU Sailor and Marine Readiness Tracker System (SMART) program for all active duty military patients with ICD-10 code for musculoskeletal conditions. Only closed LIMDU cases in which active duty patients were given a final status of RTD were included. This study analyzed top musculoskeletal ICD-10 codes, optimum period (weeks), maximum period (weeks), and average days on LIMDU assigned at NMFL centers (medical and non-medical) for fiscal years 2021 (FY21) and 2022 (FY22). As well as descriptive statistics, t-test analysis was used to test if there was a difference between FY21 and FY22 and at what point the difference was no longer significant. Critical value method was then used to compare the top five most common musculoskeletal injuries to determine the accuracy of recommended LIMDU days to actual average assigned LIMDU per injury type. A color-coded compliance chart was created based on the results. RESULTS The results showed that for RTD population, the implementation of condition-based LIMDU significantly decreased average days assigned on LIMDU by 33%. In fact, there is a 35-day (5-week) difference before we can confidently say that the difference between FY21 and FY22 is no longer statistically significant. This significant decrease in LIMDU days, before and after implementation, is a trend consistent at both medical and non-medical NMFL centers; however, medical centers reported significantly more assigned LIMDU days for both years. The five most common injuries of FY21 and FY22 were low back pain, pain in shoulder, pain in hip, pain in knee, and pain in ankle. Before implementation, all five of these injury types far exceeded the recommended amount of LIMDU days. With the new condition-based LIMDU paradigm, the average assigned LIMDU days for pain in hip, pain in knee, and pain in ankle were all found to be in compliance with the recommended LIMDU days within a 99% confidence level. CONCLUSIONS The new condition-based LIMDU paradigm is successful in its aim to improve fleet readiness by returning Sailors and Marines to full duty status significantly faster. Regular assessment of ICD-10 diagnosis codes and update to recommended LIMDU assignment timelines should be conducted to maximize the effectiveness and accuracy for all medical conditions.
Collapse
Affiliation(s)
- Christopher S Smith
- Orthopaedics Department Navy Medicine and Readiness Training Command, Portsmouth, VA 23708, USA
| | - Laura Yoon
- United States Fleet Forces Command, Norfolk, VA 23551, USA
| | - Julia N Zuppke
- Orthopaedics Department Navy Medicine and Readiness Training Command, Portsmouth, VA 23708, USA
| | - Mike Zundel
- Navy Environmental and Preventive Medicine Unit Five, San Diego, CA 92136, USA
| |
Collapse
|
3
|
Ayatizadeh SH, Borazjani R, Fereidooni R, Jamali K, Fard HA, Homaeifar R, Shayan L, Saadatjoo Z, Paydar S. Impact of COVID-19 pandemic on trauma mortality patients: A retrospective observational study in an Iranian level 1 trauma center. Health Sci Rep 2024; 7:e1883. [PMID: 38357493 PMCID: PMC10864731 DOI: 10.1002/hsr2.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims The COVID-19 pandemic has reshaped the epidemiology of various clinical conditions, including trauma which is closely tied to social policies. This study examines and compares the characteristics of trauma mortality patients, and their initial prognostic trauma scores, in the pre-pandemic and pandemic periods. Methods We conducted a retrospective observational study involving patients who passed away at a level 1 trauma center from July 23, 2018, to February 19, 2020 (prepandemic), and from February 20, 2020, to September 22, 2021 (pandemic). A subgroup analysis that matched 12 of the same months of the year in the two periods was also done. Patients who arrived deceased or passed away immediately upon arrival were excluded from data analysis. We collected and analyzed demographic and clinical data, employing the Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and ISS (TRISS) to compare initial prognoses. Results Our study encompassed 1128 patients, with 529 in the prepandemic group and 599 in the pandemic group. Demographic characteristics showed no significant differences in the number of patients in the two periods. Motor vehicle accidents remained the predominant injury mechanism in both periods. While the mean ISS increased insignificantly (22.80 vs. 22.91, p = 0.902), the mean RTS decreased (6.32 vs. 5.82), and TRISS increased (23.97% vs. 28.93%) during the pandemic (p < 0.05). Hospital length of stay decreased in the pandemic period (15.57 vs. 12.54 days, p < 0.05). Subgroup analysis revealed increased ISS, decreased RTS, and increased TRISS during the pandemic (p < 0.05). Conclusion In conclusion, while overall demographics and injury mechanisms remained virtually unchanged, trauma patients during the pandemic displayed worse estimated clinical prognoses, particularly in physiological trauma scores. The heightened mortality rate was attributed to poorer clinical conditions of patients.
Collapse
Affiliation(s)
- Seyyed HamidReza Ayatizadeh
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Roham Borazjani
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Kazem Jamali
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | | | - Reza Homaeifar
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Leila Shayan
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Zohreh Saadatjoo
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Shahram Paydar
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| |
Collapse
|
4
|
Kiernan RN, Salvitti MS, Baltazar G, Kivitz S, Sosulski A, Karev D, Celebi TB, De Mel S, Amanat S, Schulz D, Talty N, Feliciano J, DiRusso S. Racial Differences and Injury Pattern Variation: Impact of COVID-19 on a Bronx Trauma Center. Am Surg 2023; 89:5355-5364. [PMID: 36571264 PMCID: PMC9806204 DOI: 10.1177/00031348221148363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND New York City (NYC) became the epicenter of the COVID-19 pandemic in 2020. The Bronx, with the highest rates of poverty and violent crime of all NYC boroughs and a large Black and Hispanic population, was at increased risk of COVID-19 and its sequelae. We aimed to identify temporal associations among COVID-19 and trauma admission volume, demographics, and mechanism of injury (MOI). METHODS A retrospective review of prospectively collected data was conducted from a Level II trauma center in the Bronx. January 1st-September 30th for both 2019 (Pre-COVID) and 2020 (COVID) were compared. Pre-COVID and COVID cohorts were subdivided into EARLY (March-May) and LATE (June-September) subgroups. Demographics and trauma outcomes were compared. RESULTS Trauma admissions were similar between Pre-COVID and COVID. During COVID, there was an increased percentage of Black patients (Black Hispanic 20.1% vs 15.2% and Black Non-Hispanic 39.4% vs 34.1%, P < .05), younger patients (26-35 years old: 22.6% vs 17.6%, P < .05), and out-of-pocket payors (6.0% vs 1.6%, P < .05). Trauma severity outcomes were mixed-some measures supported increased severity; others showed no difference or decreased severity. During COVID, there was a rise in total penetrating injuries (27.4% vs 20.8%, P < .05), MVC (13.2% vs 7.1, P < .05), and firearm injuries (11.6% vs 6.0%, P < .05). Additionally, during LATE COVID, there was a resurgence of total penetrating, total blunt, MVC, falls, cyclists/pedestrians struck, and firearm injuries. DISCUSSION Our results emphasize MOI variations and racial differences of trauma admissions to a Level II trauma center in the Bronx during COVID-19. These findings may help trauma centers plan during pandemics and encourage outreach between trauma centers and community level organizations following future healthcare disasters.
Collapse
Affiliation(s)
- Risa N. Kiernan
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Madison S. Salvitti
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Gerard Baltazar
- Department of Surgery, NYU Langone Hospital – Long
Island, Mineola, NY, USA
| | - Scott Kivitz
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | - Dmitriy Karev
- Department of Surgery, SBH Health System, Bronx, NY, USA
| | - Taner B. Celebi
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Stephanie De Mel
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Sonia Amanat
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Dana Schulz
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Nanette Talty
- Department of Surgery, SBH Health System, Bronx, NY, USA
| | | | - Stephen DiRusso
- Department of Clinical Specialties, New York Institute of Technology
College of Osteopathic Medicine, Old Westbury, NY, USA
- Department of Surgery, SBH Health System, Bronx, NY, USA
| |
Collapse
|
5
|
Kabiri N, Abbasi A, Pashazadeh F, Hajebrahimi S, Soleimanpour H. The Impact of The COVID-19 Pandemic on Hospital Admissions Due to Road Traffic Crashes; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e12. [PMID: 38162384 PMCID: PMC10757575 DOI: 10.22037/aaem.v12i1.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Introduction During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes. Methods This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The meta-analysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes. Results A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p<0.00001]. The heterogeneity assessment of the included studies in the meta-analysis showed high heterogeneity (I2=78%, p<0.00001). Conclusion The results of this systematic review showed that the COVID-19 pandemic dramatically reduced the number of hospital admissions related to road traffic crashes because of both quarantines and lifestyle changes. Health policymakers and top health managers might use the results of this systematic review in similar contexts in the future.
Collapse
Affiliation(s)
- Neda Kabiri
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Abbasi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Urology Department, Helsinki University, Helsinki, Finland
| | - Hassan Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
6
|
Fraser JJ, MacGregor AJ, Fechner KM, Galarneau MR. Factors Associated With Neuromusculoskeletal Injury and Disability in Navy and Marine Corps Personnel. Mil Med 2023; 188:e2049-e2057. [PMID: 36515160 DOI: 10.1093/milmed/usac386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. MATERIALS AND METHODS Population-level NMSKI, limited duty (LIMDU), and long-term disability episode counts in the U.S. Navy (USN) and U.S. Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. The incidence of NMSKI, LIMDU, and long-term disability was calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. RESULTS From December 2016 to August 2021, there were 2,004,196 NMSKI episodes (USN: 3,285/1,000 Sailors; USMC: 4,418/1,000 Marines), 16,791 LIMDU episodes (USN: 32/1,000 Sailors; USMC: 29/1,000 Marines), and 2,783 long-term disability episodes (USN: 5/1,000 Sailors; USMC: 5/1,000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (relative risk, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most common, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest rates of disability, with female sex, enlisted ranks, aged 18-24 years, and service in the USMC having the most salient risk factors. CONCLUSION Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.
Collapse
Affiliation(s)
- John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Kenneth M Fechner
- Physical Therapy Department/Sports Medicine and Reconditioning Team, Naval Health Clinic Hawaii, Joint Base Pearl Harbor, HI 96860, USA
| | - Michael R Galarneau
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA 92106-3521, USA
| |
Collapse
|
7
|
Frontera WR, Latimer MR, de Jesús K, Pabón A, González J, Conde JG. Effect of the COVID-19 Pandemic on Musculoskeletal Care in the Emergency Room. Disaster Med Public Health Prep 2022; 17:e310. [PMID: 36471913 PMCID: PMC9947031 DOI: 10.1017/dmp.2022.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. METHODS Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. RESULTS Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. CONCLUSION The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.
Collapse
Affiliation(s)
- Walter R. Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Corresponding author: Walter R. Frontera,
| | - Marcos R. Latimer
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Kevin de Jesús
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Angel Pabón
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Juan González
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - José G. Conde
- Department of Biomedical Sciences Program, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| |
Collapse
|
8
|
Benner D, Hendricks BK, Elahi C, White MD, Kocharian G, Albertini Sanchez LE, Zappi KE, Garton AL, Carnevale JA, Schwartz TH, Dowlati E, Felbaum DR, Sack KD, Jean WC, Chan AK, Burke JF, Mummaneni PV, Strong MJ, Yee TJ, Oppenlander ME, Ishaque M, Shaffrey ME, Syed HR, Lawton MT. Neurosurgery Subspecialty Practice During a Pandemic: A Multicenter Analysis of Operative Practice in 7 U.S. Neurosurgery Departments During Coronavirus Disease 2019. World Neurosurg 2022; 165:e242-e250. [PMID: 35724884 PMCID: PMC9212868 DOI: 10.1016/j.wneu.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS Operative volume during the COVID-19 surge decreased 58.5% from the previous year (602 vs. 1449, P = 0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r = 0.695, P = 0.04) and increased patient categorical acuity (P = 0.001). Spine procedure volume decreased by 63.9% (220 vs. 609, P = 0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (P = 0.02). Vascular volume decreased by 39.5% (72 vs. 119, P = 0.01) but increased as a percentage of caseload (8.2% in 2019 vs. 12.0% in 2020, P = 0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs. 318, P = 0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs. 21.9% in 2019, P = 0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs. 220, P = 0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (P = 0.02). CONCLUSIONS Operative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
Collapse
Affiliation(s)
- Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K. Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D. White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gary Kocharian
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | | | - Kyle E. Zappi
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Andrew L.A. Garton
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Theodore H. Schwartz
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Daniel R. Felbaum
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Kenneth D. Sack
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Walter C. Jean
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Andrew K. Chan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - John F. Burke
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy J. Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E. Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark E. Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hasan R. Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA,To whom correspondence should be addressed: Michael T. Lawton, M.D
| |
Collapse
|
9
|
Möttönen J, Kuitunen I, Uimonen M, Mattila VM, Paloneva J, Ponkilainen V. Effect of national COVID-19 lockdown on the incidence of muscle, tendon and ligament injuries and related surgical procedures in the working-aged Finnish population. Arch Orthop Trauma Surg 2022; 143:2539-2545. [PMID: 35780198 PMCID: PMC10110679 DOI: 10.1007/s00402-022-04521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures. MATERIALS AND METHODS This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18-34, 35-50 and 51-65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017-2019. RESULTS Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33-0.80), (IRR 0.53, CI 0.31-0.91), (IRR 0.60, CI 0.38-0.95), respectively. An increase in 18-34 years of age group was detected in June (IRR 1.49, CI 1.05-2.13). Lower extremity injuries decreased in 18-34 years of age group in March (IRR 0.62, CI 0.43-0.90) and April (IRR 0.60, CI 0.42-0.87). A decrease on the incidence of surgeries was observed in April for the 35-50 (IRR 0.53, CI 0.29-0.97) and 51-65 years of age groups (IRR 0.58, CI 0.34-0.98). CONCLUSIONS The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland.
Collapse
Affiliation(s)
- Julius Möttönen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
| | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
| | - Juha Paloneva
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville Ponkilainen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| |
Collapse
|
10
|
Mittermaier P, Oxley PJ, Mian RA, Prince JM, Lee AT, Murabit A, Ratanshi I, Bone J. The 1 Year Effect of COVID-19 on Plastic Surgery Trauma at a Level One Trauma Centre: A Retrospective Review. Plast Surg (Oakv) 2022. [PMCID: PMC9247628 DOI: 10.1177/22925503221109074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Since the onset of the COVID-19 pandemic, Canada has
seen significant societal and health changes leading to the closures of many
businesses and shifts in the daily activities of many Canadians. Despite these
changes and a sharp drop in the number of patients attending emergency
departments across British Columbia (BC), little change was noted in the use of
protected plastic surgery trauma time at a level one trauma centre surveyed in
BC. The purpose of this study was to analyze and compare the changes in plastic
surgery-related trauma cases before and after the onset of the COVID-19
pandemic, both in etiology and case description. Methods: A
retrospective medical chart review was performed, evaluating all of the
participating surgeon's trauma slates in the year before and after April 1,
2020. Patient demographics, etiology, injury location, diagnosis, and surgical
timing were all recorded and analyzed using an interrupted time-series
statistical model. Results: No significant difference was observed
in any of the recorded categories across the 2 time periods. Slight increases
were noted in workplace injuries, assaults, and home-related machinery injuries.
Conclusion: The lack of significant change in workplace
injuries likely stemmed from the high number of factories and industrial plants
present in our health region, as these jobs lacked the ability to work from
home. The results of this study show that the demand for trauma-related plastic
surgery care is independent of an overall decrease in hospital admissions and
therefore should be planned and budgeted for accordingly.
Collapse
Affiliation(s)
| | - Paul J. Oxley
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Rizwan A. Mian
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Jennifer M. Prince
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Adrian T. Lee
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Amera Murabit
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Imran Ratanshi
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Jeffrey Bone
- BC Children’s’ Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
11
|
Driessen MLS, van Ditshuizen JC, Waalwijk JF, van den Bunt G, IJpma FFA, Reininga IHF, Fiddelers AA, Habets K, Homma PCM, van den Berg MH, Bloemers FW, Schipper IB, Leenen LPH, de Jongh MAC. Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study. Eur J Trauma Emerg Surg 2022; 48:2999-3009. [PMID: 35137249 PMCID: PMC9360332 DOI: 10.1007/s00068-022-01891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Purpose The SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic’s effects on the trauma care chain. Therefore, in addition to epidemiology and aetiology, this study aims to describe the impact of the SARS-CoV-2 pandemic on prehospital times, resource use and outcome. Methods A multicentre observational cohort study based on the Dutch Nationwide Trauma Registry was performed. Characteristics, resource usage, and outcomes of trauma patients treated at all trauma-receiving hospitals during the first (W1, March 12 through May 11) and second waves (W2, May 12 through September 23), as well as the interbellum period in between (INT, September 23 through December 31), were compared with those treated from the same periods in 2018 and 2019. Results The trauma caseload was reduced by 20% during the W1 period and 11% during the W2 period. The median length of stay was significantly shortened for hip fracture and major trauma patients (ISS ≥ 16). A 33% and 66% increase in the prevalence of minor self-harm-related injuries was recorded during the W1 and W2 periods, respectively, and a 36% increase in violence-related injuries was recorded during the INT. Mortality was significantly higher in the W1 (2.9% vs. 2.2%) and W2 (3.2% vs. 2.7%) periods. Conclusion The imposed restrictions in response to the SARS-CoV-2 pandemic led to diminished numbers of acute trauma admissions in the Netherlands. The long-lasting pressing demand for resources, including ICU services, has negatively affected trauma care. Further caution is warranted regarding the increased incidence of injuries related to violence and self-harm. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01891-5.
Collapse
Affiliation(s)
| | - Jan C van Ditshuizen
- Trauma Research Unit, Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Job F Waalwijk
- Network of Acute Care Limburg (NAZL), Maastricht, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, P.O Box 30.001, 9700 RB, Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Network of Acute Care Northern Netherlands (AZNN), Groningen, The Netherlands
| | | | - Karin Habets
- Network of Acute Care Eastern Netherlands (AZO), Nijmegen, The Netherlands
| | - Paulien C M Homma
- Network of Acute Care Amsterdam (SpoedzorgNet), Amsterdam, The Netherlands
| | | | - Frank W Bloemers
- Department of Surgery, Amsterdam University Medical Centre, location VU, P.O. Box 1081 HV, Amsterdam, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, P.O Box 9600, 2300 RC, Leiden, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Mariska A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| |
Collapse
|
12
|
Driessen MLS, Sturms LM, Bloemers FW, Duis HJT, Edwards MJR, den Hartog D, Kuipers EJ, Leenhouts PA, Poeze M, Schipper IB, Spanjersberg RW, Wendt KW, de Wit RJ, van Zutphen SWAM, de Jongh MAC, Leenen LPH. The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study. Ann Surg 2022; 275:252-258. [PMID: 35007227 PMCID: PMC8745885 DOI: 10.1097/sla.0000000000005300] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands. SUMMARY BACKGROUND DATA Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome. METHODS A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period). RESULTS During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012). CONCLUSIONS The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.
Collapse
Affiliation(s)
| | | | - Frank W Bloemers
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E J Kuipers
- Dutch Network for Emergency Care (LNAZ), Utrecht, The Netherlands
| | - Peter A Leenhouts
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center, Groningen, The Netherlands
| | - Ralph J de Wit
- Department of Trauma Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | | | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
13
|
Halos SH, Al-Dousari A, Anwer GR, Anwer AR. Impact of PM2.5 concentration, weather and population on COVID-19 morbidity and mortality in Baghdad and Kuwait cities. MODELING EARTH SYSTEMS AND ENVIRONMENT 2021; 8:3625-3634. [PMID: 34725645 PMCID: PMC8552206 DOI: 10.1007/s40808-021-01300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022]
Abstract
The coronavirus (COVID-19) pandemic is a global health crisis and biggest challenge facing the world. Station measurements of fine particulate matter (PM2.5) concentration in Baghdad and Kuwait during the period January–July 2020 are analyzed as well as assessment of correlation between PM2.5, weather conditions (air temperature, relative humidity, wind speed), population density and COVID-19 morbidity and mortality. A significant improvement (decrease) has observed during total and partial curfew in PM2.5 at Baghdad by 35%, 12.4%, respectively, from PM2.5 mean during the study period that is less than the WHO recommended PM2.5 level especially in total curfew. This decrease in PM2.5 pollution and people’s mobility in Baghdad at total and partial curfew contributed to decrease injuries and mortality. PM2.5 during total and partial curfew in Kuwait country witnessed increasing by 38.4% and decreasing by 22.3% from the PM2.5 mean, respectively, but still higher than WHO standard level. This increase in PM2.5 at total curfew was related to burning accidents in the oil wells which caused increasing in PM2.5 pollutant and then an increase in number of injuries and mortality during that time. In general during all study period our research found that PM2.5 and wind speed exhibit weak relation with COVID-19 morbidity and mortality but strong relation with increasing temperature and decreasing humidity. The high population density had a good association with increasing daily new cases, mortality due to COVID-19 pandemic. Thus, these factors may be taken into consideration in policy development for the control and prevention of new chains of the Coronavirus pandemic.
Collapse
Affiliation(s)
- Saadiyah H Halos
- Atmosphere and Space Science Center, Directorate of Space Technology and Communication, Ministry of Science and Technology, Baghdad, Iraq
| | - Ali Al-Dousari
- Crisis Decision Support Program, Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, P.O. Box 24885, 13109 Safat, Kuwait
| | | | - Amany R Anwer
- University of Baghdad / Al-Kindy College of Medicine, Baghdad, Iraq
| |
Collapse
|
14
|
Saini N, Ranjan R, Jain VK, Shukla A. Pooling of neglected and delayed trauma patients - Consequences of 'lockdown' and 'Unlock' phases of COVID-19 pandemic- A retrospective cohort analysis from a tertiary centre. J Clin Orthop Trauma 2021; 21:101533. [PMID: 34334981 PMCID: PMC8312047 DOI: 10.1016/j.jcot.2021.101533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in nationwide lockdown and quarantine strategies to break the chain of transmission of the SARS-CoV-2 virus in India. Management of patients with trauma has been particularly challenging across the country. AIMS To evaluate the effect of delay in surgery in patients with traumatic injuries along with the peri-operative outcomes during the 'Lockdown' and 'Unlock' phases of the COVID-19 pandemic at a Level I Trauma centre in the National Capital Region (NCR) of India. METHODS This retrospective, observational cohort study included 488 patients. Comparative analysis to assess patient characteristics, mechanism of trauma, clinical outcomes in patients managed operatively during 'Lockdown period' (24 March 2020 to 31 May 2020) Group A with Group B, who presented during 'Unlock phases' (01 June 2020 to 31 December 2020). RESULTS The average delay in surgery, surgical time and hospital stay was significantly increased in group B patients (p-value <0.05). The average blood loss, stay in the Intensive Care Unit (ICU) and blood transfusion requirement were clinically higher in group B but these differences were not statistically significant (p-value >0.05). Only in group B; 9.01% patients (42 out of 466) required bone grafting. CONCLUSION 'Neglect' and delay in receiving operative management of orthopaedic trauma has led to unprecedented rise in number of complications of fractures, such as mal-union, delayed union or non-union during COVID-19 Pandemic. Patients have had to undergo longer surgical procedures with increased risk of intra-operative blood loss, need of peri-operative blood transfusion and bone grafting supplementation to facilitate union. Diligent attention to achieve the most optimal configuration of fractures should be planned in conservatively managed injuries during the pandemic to minimize future intra-operative difficulties.
Collapse
Affiliation(s)
- Naresh Saini
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ravi Ranjan
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ajay Shukla
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| |
Collapse
|
15
|
Faulkner A, MacDonald DRW, Neilly DW, Davies PSE, Ha TT, Stevenson IM, Jariwala AC. Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: A multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study. Surgeon 2021; 20:252-257. [PMID: 34183264 PMCID: PMC9451541 DOI: 10.1016/j.surge.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Abstract
Introduction The COVID-19 lockdown resulted in decreased vehicle use and an increased uptake in cycling. This study investigated the trends in cycling-related injuries requiring orthopaedic intervention during the COVID-19 lockdown period compared with similar time periods in 2018 and 2019. Methods Data were collected prospectively for patients in 2020 and collected retrospectively for 2019 and 2018, from hospitals within four NHS Scotland Health Boards encompassing three major trauma centres. All patients who sustained an injury as a result of cycling requiring orthopaedic intervention were included. Patient age, sex, mechanism of injury, diagnosis and treatment outcome from electronic patient records. Results Number of injuries requiring surgery 2020: 77 (mean age/years – 42.7); 2019: 47 (mean age/years - 42.7); 2018: 32 (mean age/years – 31.3). Overall incidence of cycling injuries 2020: 6.7%; 2019: 3.0%; 2018: 2.1%. Commonest mechanism of injury: fall from bike 2020 n = 54 (70.1%); 2019 n = 41 (65.1%); 2018 n = 25 (67.6%). Commonest injury type: fracture 2020 n = 68 (79.1%); 2019 n = 33 (70.2%); 2018 n = 20 (62.5%). Commonest areas affected: Upper extremity: 2020 n = 45 (58.5%); 2019 n = 25 (53.2%); 2018 n = 25 (78.1%). Lower extremity: 2020 n = 23 (29.9%); 2019 n = 14 (29.7%); 2018 n = 7 (21.8%). Conclusion A significant increase in the number of cycling related injuries requiring orthopaedic intervention, a greater proportion of female cyclists and an older mean age of patients affected was observed during the COVID-19 lockdown period compared with previous years. The most common types of injury were fractures followed by lacerations and fracture-dislocations. The upper extremity was the commonest area affected.
Collapse
Affiliation(s)
- Alastair Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK.
| | - David R W MacDonald
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - David W Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Peter S E Davies
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK
| | - Taegyeong T Ha
- Department of Trauma and Orthopaedics Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
| | - Iain M Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Arpit C Jariwala
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK
| | | |
Collapse
|
16
|
Dowell RJ, Ashwood N, Hind J. Musculoskeletal Attendances to a Minor Injury Department During a Pandemic. Cureus 2021; 13:e13143. [PMID: 33728156 PMCID: PMC7935292 DOI: 10.7759/cureus.13143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: As coronavirus disease 2019 (COVID-19) became a public health emergency of international concern, countries across the globe began to instate strict social distancing restrictions or “lockdowns”. During these times emergency departments in the United Kingdom (UK) recorded a significant drop in patients attending when compared to the same months of previous years. Attendances related to musculoskeletal (MSK) trauma also saw a significant drop in numbers Objective: The purpose of this retrospective audit was to investigate patterns of injuries attending during the pandemic and more specifically during times of lockdown. Method: Retrospective audit data was collected from an electronic medical record system (MediTech V6) during the time period of the first lockdown in the UK. Data was collected for patients attending the emergency department at the Queens Hospital Burton site of the University Hospitals of Derby and Burton National Health Service (NHS) Trust. Presenting complaints were recorded for the entire emergency department, and diagnosis on discharge and activity status was recorded for minor injuries only. This data was then compared to the same date from 2019. Results: Overall attendances in the emergency department decreased by 45.42% during the first lockdown when compared to the same time period in 2019. MSK problems also saw a significant drop as back pain decreased by 58.88%, neck pain fell by 78.52% and limb problems decreased by 59.74%. When comparing data from the minor injury department, limb problems decreased by 20.45%. The number of soft tissue injuries decreased by 24.05% and fractures decreased by 7.96%. Conclusion: Attendances in the emergency department were greatly reduced during the COVID-19 pandemic, especially during the first lockdown. The rates of fractures and soft tissue injuries within the minors’ area of the emergency department were also reduced but not at the same rate as the overall attendance. A large number of fractures and soft tissue injuries still presented to the emergency department despite reduced national activity. These attendances may be as a result of the increased rate of Do It Yourself (DIY)-related injuries and altered patient/social behaviour due to lockdown, social distancing, and seasons/weather. Further research would be required to investigate the changing patterns of behaviour especially as we enter a second wave of cases.
Collapse
Affiliation(s)
- Richard J Dowell
- Emergency Department, University Hospitals of Derby and Burton, Derby, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Derby, GBR
| | - Jamie Hind
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| |
Collapse
|