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Otremski H, Dermott J, Page K, Ipp LS, Blanco JS, Studer D, Sigal A, Kim D, Hasler CC, Lebel DE, Widmann RF, Ovadia D. The global impact of the COVID-19 pandemic on pediatric spinal care: A multi-centric study. J Child Orthop 2024; 18:33-39. [PMID: 38348438 PMCID: PMC10859112 DOI: 10.1177/18632521231210356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/08/2023] [Indexed: 02/15/2024] Open
Abstract
Background The COVID-19 pandemic has affected healthcare worldwide since December 2019. We aimed to identify the effect of the COVID-19 pandemic on outpatient clinic and surgical volumes and peri-operative complications for pediatric spinal deformities patients. Methods In this multi-center retrospective study, outpatient visits (in-person and virtual care) and pediatric spine surgeries volumes in four high-volume pediatric spine centers were compared between March and December 2019 and the same period in 2020. Peri-operative complications were collected and compared in the same periods. Descriptive statistics were calculated, and comparative analyses were performed. Results During the 2020 study period, the outpatient visit (in-person and virtual care) volume decreased during local lockdown periods by 71% for new patients (p < 0.001) and 53% for returning patients (p = 0.03). Overall, for 2020, there was a 20% reduction in new patients (p = 0.001) and 21% decrease in returning patients (p < 0.001). During the pandemic, there was also 20% less overall surgical volume of adolescent idiopathic scoliosis (AIS) patients undergoing primary posterior spinal fusion, with a 70% reduction during lockdown times (p < 0.001). Complication rate and profile were similar between periods. Conclusion There was a significant decrease in outpatient pediatric spine outpatient visits, particularly new patients, which may increase the proportion of pediatric patients with spinal deformities that present late, meeting surgical indication. This, in combination with the reduction in surgical volume of AIS over the first year of the pandemic, could result in an extended waitlist for surgeries during years to come. Complication rate was similar for both periods, suggesting it is safe to continue elective pediatric spine surgery even in a time of a pandemic. Level of evidence level IV.
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Affiliation(s)
- Hila Otremski
- Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jennifer Dermott
- The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kira Page
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Lisa S Ipp
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John S Blanco
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Studer
- Orthopaedic Department, Children’s Hospital, University of Basel, Basel, Switzerland
| | - Amit Sigal
- Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorothy Kim
- The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carol C Hasler
- Orthopaedic Department, Children’s Hospital, University of Basel, Basel, Switzerland
| | - David E Lebel
- The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roger F Widmann
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Dror Ovadia
- Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tarchala M, Bradley CS, Grant S, Verma Y, Camp M, Matava C, Kelley SP. The impact of public health lockdown measures during the COVID-19 pandemic on the epidemiology of children's orthopedic injuries requiring operative intervention. Can J Surg 2024; 67:E49-E57. [PMID: 38320778 PMCID: PMC10852194 DOI: 10.1503/cjs.002723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In March 2020, Ontario instituted a lockdown to reduce spread of the SARS-CoV-2 virus. Schools, recreational facilities, and nonessential businesses were closed. Restrictions were eased through 3 distinct stages over a 6-month period (March to September 2020). We aimed to determine the impact of each stage of the COVID-19 public health lockdown on the epidemiology of operative pediatric orthopedic trauma. METHODS A retrospective cohort study was performed comparing emergency department (ED) visits for orthopedic injuries and operatively treated orthopedic injuries at a level 1 pediatric trauma centre during each lockdown stage of the pandemic with caseloads during the same date ranges in 2019 (prepandemic). Further analyses were based on patients' demographic characteristics, injury severity, mechanism of injury, and anatomic location of injury. RESULTS Compared with the prepandemic period, ED visits decreased by 20% (1356 v. 1698, p < 0.001) and operative cases by 29% (262 v. 371, p < 0.001). There was a significant decrease in the number of operative cases per day in stage 1 of the lockdown (1.3 v. 2.0, p < 0.001) and in stage 2 (1.7 v. 3.0; p < 0.001), but there was no significant difference in stage 3 (2.4 v. 2.2, p = 0.35). A significant reduction in the number of playground injuries was seen in stage 1 (1 v. 62, p < 0.001) and stage 2 (6 v. 35, p < 0.001), and there was an increase in the number of self-propelled transit injuries (31 v. 10, p = 0.002) during stage 1. In stage 3, all patient demographic characteristics and all characteristics of operatively treated injuries resumed their prepandemic distributions. CONCLUSION Provincial lockdown measures designed to limit the spread of SARS-CoV-2 significantly altered the volume and demographic characteristics of pediatric orthopedic injuries that required operative management. The findings from this study will serve to inform health system planning for future emergency lockdowns.
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Affiliation(s)
- Magdalena Tarchala
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Catharine S Bradley
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Samuel Grant
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Yashvi Verma
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Mark Camp
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Clyde Matava
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
| | - Simon P Kelley
- From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
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Wong C, Bent MA, Omar H, Abousamra O. Launching telemedicine in a tertiary ambulatory pediatric orthopedic clinic during the coronavirus disease-19 pandemic: a retrospective study. J Pediatr Orthop B 2024; 33:97-102. [PMID: 36723520 DOI: 10.1097/bpb.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Telemedicine services increased dramaticallyduring the coronavirus disease (COVID-19) pandemic, with limited studies on its implementation within pediatric orthopedics. The goal of this study was to examine patient satisfaction and the efficacy of pediatric orthopedic telemedicine visits. Two hundred and sixty-nine qualifying telehealth visits took place at a metropolitan area pediatric institute between 1 March and 30 May 2020. Patients were invited to complete an anonymous satisfaction survey on their telemedicine experience. Sixty-seven patients responded to the survey. A chart review was completed for all 269 telemedicine visits. Ninety-two percent (249/269) of telemedicine visits were with established patients, and 95% (256/269) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telemedicine visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5). Our analysis showed that telemedicine is a viable alternative to in-person visits for various pediatric orthopedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telemedicine visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients' perceived value of an in-person evaluation. Our study's findings should encourage the continued implementation of pediatric orthopedic telemedicine as an adjunct to in-person clinical practice.
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Affiliation(s)
- Cynthis Wong
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas
| | - Melissa A Bent
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Hanna Omar
- Children's Hospital of Los Angeles, Children's Orthopedic Center
| | - Oussama Abousamra
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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Messler V, Leschinger T, Ott N, Rausch V, Burst V, Eysel P, Müller LP, Hackl M. The impact of the SARS-CoV-2 pandemic-related lockdowns on orthopedic trauma emergencies at a level-one trauma center. Arch Orthop Trauma Surg 2023; 143:6201-6208. [PMID: 37341804 PMCID: PMC10491551 DOI: 10.1007/s00402-023-04947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The SARS-CoV-2 pandemic and its associated lockdowns had a profound effect on orthopedic trauma emergencies. This study aimed to investigate the patient volume and injury patterns at a level-one trauma center during the SARS-CoV-2 pandemic and compare them to the pre-pandemic conditions. MATERIALS AND METHODS A retrospective chart review of all patients who presented to the orthopedic trauma emergency department of a level-one trauma center in Cologne, Germany within a 2 year period from March 16th, 2019 to March 15th, 2020 (pre-pandemic control) and from March 16th, 2020 and March 15th, 2021 (pandemic) was performed. The pandemic year was separated into three periods: (1) first lockdown, (2) between lockdowns and (3) second lockdown. The absolute numbers of patient presentations, the Manchester triage score (MTS) and the relative proportion of patients with structural organ injuries, fractures and dislocations, of polytraumatized patients, of hospital admissions, of subsequent emergency or semi-elective surgeries and of work-related accidents were evaluated in comparison to the pre-pandemic control. RESULTS A total of 21,642 patient presentations were included in this study. Significantly less weekly orthopedic trauma emergency patient presentations were recorded during the pandemic (p < 0.01). The MTS was significantly lower during the first lockdown and between lockdowns (p < 0.01). The proportional incidence of overall structural organ injuries, fractures and dislocations, of upper limb fractures/dislocations, of hospital admissions and of patients requiring surgery was significantly increased during the pandemic (p ≤ 0.03). The proportional incidence of work-related injuries was significantly decreased during the pandemic (p < 0.01). CONCLUSIONS Orthopedic trauma emergency presentations were reduced during the SARS-CoV-2 pandemic. Due to the reluctancy of patients to visit the emergency department during the pandemic, the proportions of relevant injuries in general and of upper limb injuries in particular as well as of patients requiring hospital admission and trauma-related surgery were significantly increased.
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Affiliation(s)
- Valentin Messler
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Nadine Ott
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Valentin Rausch
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Volker Burst
- Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peer Eysel
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Lars Peter Müller
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine, University Hospital Cologne, Center of Orthopedic and Trauma Surgery, and University of Cologne, Cologne, Germany.
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Muhammad MI, Umoga K, Acquaye A, Fleischer B, Konkwo C, Ogunyemi KO, Ngaruiya C. Provider-identified barriers to performance at seven Nigerian accident & emergency units: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001909. [PMID: 37216332 DOI: 10.1371/journal.pgph.0001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Nigeria hosts much of Africa's morbidity and mortality from emergency medical conditions. We surveyed providers at seven Nigerian Accident & Emergency (A&E) units about (i) their unit's ability to manage six major types of emergency medical condition (sentinel conditions) and (ii) barriers to performing key functions (signal functions) to manage sentinel conditions. Here, we present our analysis of provider-reported barriers to signal function performance. METHODS 503 Health Providers at 7 A&E units, across 7 states, were surveyed using a modified African Federation of Emergency Medicine (AFEM) Emergency Care Assessment Tool (ECAT). Providers indicating suboptimal performance ascribed this performance to any of eight multiple-choice barriers [infrastructural issues, absent and broken equipment, inadequate training, inadequate personnel, requirement of out-of-pocket payment, non-indication of that signal function for the sentinel condition, and hospital-specific policies barring signal function performance] or an open-ended "other" response. The average number of endorsements for each barrier was obtained for each sentinel condition. Differences in barrier endorsement were compared across site, barrier type and sentinel condition using a three-way ANOVA test. Open-ended responses were evaluated using inductive thematic analysis. Sentinel conditions were Shock, Respiratory Failure, Altered Mental Status, Pain, Trauma, and Maternal & Child Health. Study sites were the University of Calabar Teaching Hospital, the Lagos University Teaching Hospital, the Federal Medical Center, Katsina, the National Hospital Abuja, the Federal Teaching Hospital Gombe, the University of Ilorin Teaching Hospital (Kwara), and the Federal Medical Center Owerri (Imo). FINDINGS Barrier distribution varied widely by study site. Just three study sites shared any one barrier to signal function performance as their most common. The two barriers most commonly endorsed were (i) non-indication of, and (ii) insufficient infrastructure to perform signal functions. A three-way ANOVA test found significant differences in barrier endorsement by barrier type, study site and sentinel condition (p<0.05). Thematic analysis of open-ended responses highlighted (i) considerations disfavoring signal function performance and (ii) lack of experience with signal functions as barriers to signal function performance. Interrater reliability, calculated using Fleiss' Kappa, was found to be 0.5 across 11 initial codes and 0.51 for our two final themes. INTERPRETATION Provider perspective varied with regards to barriers to care. Despite these differences, the trends seen for infrastructure reflect the importance of sustained investment in Nigerian health infrastructure. The high level of endorsement seen for the non-indication barrier may signal need for better ECAT adaptation for local practice & education, and for improved Nigerian emergency medical education and training. A low endorsement was seen for patient-facing costs, despite the high burden of Nigerian private expenditure on healthcare, indicating limited representation of patient-facing barriers. Analysis of open-ended responses was limited by the brevity and ambiguity of these responses on the ECAT. Further investigation is needed towards better representation of patient-facing barriers and qualitative approaches to evaluating Nigerian emergency care provision.
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Affiliation(s)
| | - Kelechi Umoga
- Harvard Medical School, Massachusetts General Hospital/Brigham Women's Hospital, Cambridge, Massachusetts, United States of America
| | - Amber Acquaye
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Brian Fleischer
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Chigoziri Konkwo
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Kehinde Olawale Ogunyemi
- Department of Community Medicine, Babcock University Teaching Hospital, Ilisham-Remo, Ogun State, Nigeria
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. [Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:36-40. [PMID: 34188721 PMCID: PMC8229904 DOI: 10.1016/j.rcot.2021.04.021] [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: 05/13/2020] [Accepted: 09/28/2020] [Indexed: 02/02/2023]
Abstract
Introduction La période de confinement de 8 semaines, imposée en raison de l’épidémie liée au Covid-19, a entraîné une restriction de la circulation, un arrêt de la scolarité et des activités sportives. Notre hypothèse est que cette situation inédite a modifié temporairement l’épidémiologie des traumatismes chez l’enfant. Matériel et méthode Il s’agit d’une étude prospective réalisée pendant les 8 semaines de confinement. L’activité d’urgence traumatologique pédiatrique a été comparée à l’activité des 3 années précédentes à la même période. Résultats Pendant le confinement, le taux de passage aux urgences a diminué de 50 %. Le taux de patients opérés représentait 86 % par rapport aux 3 années précédentes. Les patients opérés pendant le confinement avaient une moyenne d’âge de 7,6 ans (âge médian 7,5) contre 9,3 ans (âge médian 9,4) les années précédentes. On notait une augmentation des accidents domestiques (59 % versus 23 %) et des accidents de trampoline (16 % versus 5 %), et une diminution des accidents de sport et des accidents de locomotion. Les plaies étaient plus fréquentes en période de confinement, représentant 35 % des actes chirurgicaux contre 13 % les années précédentes. Le nombre de patients opérés pour fracture au membre supérieur a diminué alors qu’il restait similaire pour le membre inférieur. Les fractures distales de l’avant-bras étaient moins fréquentes, ainsi que les fractures distales de jambe. Discussion Notre étude a montré pendant le confinement une réduction de 50 % de l’activité de traumatologie aux urgences sans diminution de l’activité au bloc opératoire. En cas de nouvelle période de confinement, nous recommanderions une réorganisation de l’accueil aux urgences permettant de libérer des équipes pour l’accueil des patients Covid-19; et le maintien d’un bloc opératoire pour les urgences chirurgicales. Une information pourrait être proposée au public pour la prévention des accidents domestiques, ainsi que des risques liés aux activités de trampoline. Niveau de preuve III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France,Auteur correspondant
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study. Orthop Traumatol Surg Res 2023; 109:102946. [PMID: 33901717 PMCID: PMC8064820 DOI: 10.1016/j.otsr.2021.102946] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The 8-week lockdown for the Covid-19 epidemic in France restricted travel, and interrupted schooling and sports. The study hypothesis was that this exceptional situation temporarily altered childhood trauma epidemiology. MATERIAL AND METHOD A prospective study was performed during the 8 weeks of lockdown. Pediatric traumatology emergency activity was compared to that during the same period in the previous 3 years. RESULTS During lockdown, emergency consultations decreased by 50%. The number of patients operated on was 86% of that in the previous 3 years. Patients operated on during lockdown had a mean age of 7.6 years (median, 7.5 years) compared to 9.3 years (9.4 years). The rate of domestic accidents (59% versus 23%) and trampoline accidents (16% versus 5%) increased, while those of sport and locomotion-related accidents decreased. Wounds were more frequent, at 35% of procedures, versus 13% previously. The rate of surgery for upper-limb fracture deceased, while that of lower-limb fracture was unchanged. Distal forearm fracture was less frequent, as was distal tibial fracture. DISCUSSION The present study found a 50% decrease in pediatric traumatology emergency activity during lockdown, without decrease in surgery. In case of renewed lockdown, we recommend reorganizing emergency admission to free teams for management of Covid-19 patients, while maintaining operative rooms for emergency surgery. A general public information campaign could help prevent domestic accidents and risk related to use of trampolines. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France,Corresponding author
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
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Salom Taverner M, Martí Ciruelos R, Fernández Ansorena A, Alvarez Muñoz M, García-Chamorro M, Muñoz López C, Sanpera Trigueros I. [Translated article] Effect of the COVID pandemic on paediatric trauma emergencies in three areas of Spain with different incidence. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T43-T50. [PMID: 35858670 PMCID: PMC9288353 DOI: 10.1016/j.recot.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction and objectives Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analysed whether the incidence of infection or different organisation of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced paediatric trauma emergencies during the first wave of the pandemic. Material and methods We present a retrospective cohort study that compares and analyzes paediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. Results A total of 6474 paediatric trauma emergency episodes have been analysed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. Conclusions The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on paediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.
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Levy M, Lestrade V, Said C, Jouvet P, Kawaguchi A. Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review. Front Pediatr 2022; 10:874045. [PMID: 35722481 PMCID: PMC9204064 DOI: 10.3389/fped.2022.874045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU). Methods We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 including pre-print engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries, compared to the historical cohort in each studied region, country, or hospital. Results We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. A significant decline was reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. Conclusions SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. However, some disease groups, such as burns and DKA, showed a tendency to increase and its severity of illness at hospital presentation. Continual effort and research into the subject should be essential for us to better understand the effects of this new phenomenon of SDMs to protect the well-being of children. Systematic Review Registration Clinicaltrials.gov, identifier: CRD42020221215.
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Affiliation(s)
- Michael Levy
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Robert-Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Victor Lestrade
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Carla Said
- School of Medicine, University of Paris Saclay, Paris, France
| | - Philippe Jouvet
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Atsushi Kawaguchi
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Department of Intensive Care Medicine, Pediatric Critical Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
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10
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Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe. Eur J Trauma Emerg Surg 2022; 48:4385-4402. [PMID: 35523966 PMCID: PMC9075714 DOI: 10.1007/s00068-022-01978-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/16/2022] [Indexed: 12/13/2022]
Abstract
Purpose This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible. Results 57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%. Conclusion The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully. Level of evidence Level IV, systematic review.
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Salom Taverner M, Martí Ciruelos R, Fernández Ansorena A, Alvarez Muñoz M, García-Chamorro M, Muñoz López C, Sanpera Trigueros I. Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en tres zonas de España con distinta incidencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:461-468. [PMID: 35504506 PMCID: PMC9055783 DOI: 10.1016/j.recot.2022.02.006] [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] [Received: 10/14/2021] [Revised: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introducción y objetivos Aunque se ha publicado mucho sobre el efecto de la pandemia en las urgencias traumatológicas, no se ha analizado si la incidencia de la infección o la distinta organización de los recursos disponibles según la comunidad autónoma fueron factores influyentes. Presentamos un estudio multicéntrico de tres hospitales terciarios de tres ciudades españolas con distintas características para estudiar cómo estos factores influyeron a las urgencias traumatológicas pediátricas durante la primera ola de la pandemia. Material y métodos Presentamos un estudio retrospectivo de cohortes que compara y analiza las urgencias traumatológicas pediátricas en tres hospitales distintos durante el periodo de la primera ola de la pandemia COVID-19 y comparamos sus resultados con los del mismo periodo del año anterior, analizando el número de urgencias, la gravedad de la patología, la edad media de los pacientes, los días de ingreso y el tiempo de espera de los casos que requirieron tratamiento quirúrgico. Resultados Se han analizado 6.474 episodios de urgencias traumatológicas infantiles. Se produjo una drástica reducción de la actividad en los tres hospitales, pero en distinta cuantía: del 83,5% en el hospital localizado en Madrid, del 75% en el hospital localizado en Valencia y del 65,9% en el ubicado en Palma de Mallorca. Las urgencias atendidas fueron de mayor gravedad en el año 2020 en comparación con el año 2019. La edad media de los pacientes atendidos durante la pandemia fue menor en comparación con el año anterior. No hubo diferencias en los días de ingreso, pero sí en la demora de la cirugía de las fracturas quirúrgicas. Conclusiones La repercusión de la primera ola de la pandemia COVID-19 y el confinamiento decretado tuvieron una repercusión distinta en las urgencias traumatológicas pediátricas en los distintos hospitales según la incidencia de la infección y las medidas adoptadas en las diferentes comunidades autónomas. En todos los casos hubo una reducción importante de la actividad, se atendió una mayor proporción de patología media y grave, la edad media de los pacientes atendidos fue menor y se observó un retraso en las cirugías realizadas en urgencias, probablemente por la necesidad de solicitar una prueba PCR para detectar una infección por COVID-19.
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Chand S, Khan D, Afaque SF, Verma V, Huda N, Singh A. Impact of COVID-19 pandemic on clubfoot program at tertiary care institute. J Clin Orthop Trauma 2022; 24:101711. [PMID: 34815627 PMCID: PMC8603262 DOI: 10.1016/j.jcot.2021.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/29/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The COVID-19 pandemic had serious impact on health care sector. During reprioritisation of the services, elective and non-emergency procedures were suspended, with gradual resumption of services after lockdown was over. In this study we assessed the impact of pandemic on our clubfoot program at a tertiary care institute. Also, we discussed the future challenges and strategies to re-start our clubfoot program. METHODS Data was collected retrospectively regarding registrations, demography and procedures done at our clubfoot centre. Study period was 25 March to 31 December 2020 and it was compared with same duration from previous years 2019 and 2018. After the data analysis, the findings were discussed on departmental committee meeting, future challenges were considered and strategies were charted out for re-establishing the clubfoot program at our Institute. RESULTS When compared to previous year, we noted 46% decline in paediatric outpatient registrations and 60% decline in new clubfoot registrations at our centre. The clubfoot follow-up visits reduced by 30% in the pandemic year 2020. 80% of clubfoot registrations were local residents during pandemic year, which was 54%, 58% in year 2019 and 2018 respectively. The percentage of neglected cases remained stable, however, share of relapse cases increased during pandemic year. There was 80% decline in number of tenotomies and 90% decline in other clubfoot surgeries performed during pandemic year 2020 compared to year 2019. CONCLUSION COVID-19 pandemic had definite disruptive impact on our clubfoot program. With decreased new registrations, follow-up visits and increased relapses, we anticipate a significant increase in clubfoot cases in need of casting & treatment. To deal with pent-up demand and an anticipated wave of relapse and neglected clubfoot cases, we have proposed strategies to re-establish clubfoot program in post-pandemic new-normal. We hope these will prepare us for any adversaries we face.
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Affiliation(s)
- Suresh Chand
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Danish Khan
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Syed Faisal Afaque
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Vikas Verma
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Najmul Huda
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
| | - Ajai Singh
- Department of Paediatric Orthopaedics, King George's Medical University, Lucknow, India
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Zacay G, Modan-Moses D, Tripto-Shkolnik L, Levy-Shraga Y. Decreases in pediatric fractures during the COVID-19 pandemic - a nationwide epidemiological cohort study. Eur J Pediatr 2022; 181:1473-1480. [PMID: 34993624 PMCID: PMC8739001 DOI: 10.1007/s00431-021-04323-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023]
Abstract
The COVID-19 pandemic led to fundamental changes in daily routines of children. Our aim was to evaluate the incidence and characteristics of fractures among Israeli children during 2020 compared with 2015-2019. Demographic, clinical data, and incidence rates of fractures in individuals aged < 18 years were derived from the electronic database of Meuhedet Health Services, which provides healthcare services to 1.2 million people in Israel. We further subdivided the year to five periods according to government regulations of lockdown and isolation at each period. Fracture sites were determined according to ICD9 definitions. During 2020, 10,701 fractures occurred compared with 12,574 ± 599 fractures per year during 2015-2019 (p-value < 0.001). Fracture rates were lower during all periods in 2020. The largest decline was observed during the first lockdown for both boys (56% decline, 95% confidence interval [CI] 52-60%) and girls (47% decline CI 41-53%). While the fracture rate declined for most age groups, the largest decline was recorded for the age group 11-14 years, with significant reduction rates of 66% (CI 59-71%) for boys and 65% (CI 54-73%) for girls. The most prominent declines were of fractures of the hand bones of both boys and girls (64% and 59%, respectively). Conclusions: Our data showed a significant decrease in fracture rate in 2020 compared to the previous 5 years, as well as differences between periods within that year. What is New: •The COVID-19 pandemic led to fundamental change in daily routines of children with significant decrease in school attendance and sport activities. •Consequent to these public health measures, the incidence rate of pediatric fractures decreased significantly. What is New: •This study demonstrates declines in fracture rates during lockdown periods, with only partial reversing of the trends between the lockdown periods. •The most pronounced decline was observed during the first lockdown period. •The decline was most prominent in children aged 11-14 years; there was no significant change in fracture incidence of children aged <3 years.
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Affiliation(s)
- Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Dalit Modan-Moses
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Liana Tripto-Shkolnik
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Levy-Shraga
- Meuhedet Health Services, Tel Aviv, Israel.
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Ethical responsibilities of European children's teams facing the resurgent COVID-19 pandemic. Eur J Pediatr 2022; 181:207-213. [PMID: 34241684 PMCID: PMC8266989 DOI: 10.1007/s00431-021-04185-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/15/2021] [Accepted: 06/24/2021] [Indexed: 10/25/2022]
Abstract
The COrona VIrus Disease 2019 (COVID-19) pandemic is posing an unprecedented challenge to healthcare systems around the globe. Europe has been struggling for 1 year now, and despite some encouraging progress (above all, the beginning of vaccination), the second wave is ongoing. Even though children are less affected than adults, the COVID-19 pandemic-and in particular the measures to counter it-is having a considerable impact on the paediatric healthcare setting. It is, therefore, the duty of paediatric teams in Europe to prepare for the challenges ahead. We wish to contribute to this necessary preparedness in two ways: firstly, by assessing the direct and indirect impact of the pandemic on children and on the paediatric setting; secondly, and more importantly, by identifying the various responsibilities of paediatric healthcare professionals, in light of established ethical principles. Only abiding by these responsibilities will it be possible to ensure that ill children and their families are properly supported even in these difficult times and to grant that decisions about children's healthcare remain morally justified and lawful. What is Known: • The COVID-19 outbreak is posing an unprecedented challenge to healthcare systems around the globe • Despite the children are less affected than adults, the COVID-19 pandemic is having a huge impact also on paediatric setting What is New: • The COVID-19 pandemic lays out specific responsibilities of paediatric professionals towards our pa-tients, society and ourselves • The paediatric teams in Europe should assess the direct and indirect impact of the pandemic on the chil-dren and on the paediatric settings, ensuring consistency between centres and across regions in Europe.
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15
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Gokhale S, D'sa P, Badurudeen AA, Carpenter EC. Epidemiology of Paediatric Orthopaedic Trauma, Before, During, and After the Outbreak of COVID-19 Pandemic: An Observational Study From a Tertiary Referral Center in Wales. Cureus 2021; 13:e19253. [PMID: 34900454 PMCID: PMC8648141 DOI: 10.7759/cureus.19253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The outbreak of coronavirus disease 2019 (COVID-19) and the resultant lockdown has had a great impact on global healthcare. This observational study aimed to analyse the consequences of national lockdown on the epidemiology of significant paediatric orthopaedic trauma, presenting to a tertiary referral centre in Wales, during the COVID-19 pandemic in the United Kingdom. Methods Paediatric patients presenting with orthopaedic trauma, from March 2019 to July 2019 (baseline period), March 2020 to July 2020 (lockdown period), and March 2021 to July 2021 (post lockdown period), were identified and compared. Those aged less than 16 years, presenting with a significant orthopaedic injury, defined here for the study as, those requiring either manipulation under anaesthesia or, surgical intervention were included in this study. Results Mean age of children with significant orthopaedic injuries during the lockdown dropped significantly to 6.52 years in comparison to those during the baseline period (7.9 years), and post lockdown period (8.85 years). The incidence of outdoor injuries plummeted significantly from 64.71% in the baseline period, to 41.27% during the lockdown period, but rose to 80.65% in the post lockdown period. There was a 48% reduction in the number of children who required intervention in operating theatre during the lockdown period, in comparison to the other two study periods. Conclusion Our study reports a significant decrease in the incidence of paediatric orthopaedic trauma needing intervention in operating theatre during the lockdown period, with a significant rise in the incidence of domestic injuries, and relatively younger children sustaining these injuries. A public information campaign could help reduce the incidence of such domestic accidents during future lockdowns. We recommend improving awareness among parents, creating a safe indoor as well as outdoor environment to help reduce the incidence of fractures in the paediatric population. This will subsequently help in reducing the financial burden on an already stretched healthcare system.
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Affiliation(s)
- Sandeep Gokhale
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
| | - Prashanth D'sa
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
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Kumar A, Sinha S, Jameel J, Kumar S. Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review. J Taibah Univ Med Sci 2021; 17:203-213. [PMID: 34690642 PMCID: PMC8521392 DOI: 10.1016/j.jtumed.2021.09.003] [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: 06/22/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Gibbard M, Ponton E, Sidhu BV, Farrell S, Bone JN, Wu LA, Schaeffer E, Cooper A, Aroojis A, Mulpuri K. Survey of the Impact of COVID-19 on Pediatric Orthopaedic Surgeons Globally. J Pediatr Orthop 2021; 41:e692-e697. [PMID: 34171889 PMCID: PMC8357035 DOI: 10.1097/bpo.0000000000001887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic required rapid, global health care shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopaedic surgeons during this time. We aimed to investigate COVID-19-related changes in practice, training, and research among pediatric orthopaedic surgeons globally. METHODS An online survey was administered to orthopaedic surgeons with interest in pediatrics in April 2020 and a follow-up was administered in February 2021. The surveys captured demographics and surgeons' self-reported experiences during the pandemic. Participants were recruited from web media and available email lists of orthopaedic societies over a 2-month period. Descriptive statistics were used to analyze results, stratified by the severity of local COVID-19-related measures. RESULTS A total of 460 responses from 45 countries were collected for initial survey. Of these, 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported a reduction in the average number of surgeries per week, from 6.89 (SD=4.61) prepandemic to 1.25 (SD=2.26) at time of survey (mean difference=5.64; 95% confidence interval=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) prepandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% confidence interval=5.61, 60.58). In total, 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported implementation of systems to continue training such as webinars or virtual rounds. Of 192 respondents with research, 149 (82.8%) reported continuing research activities during the pandemic with most reporting either cessation (n=75, 64.15%), or reduction (n=25, 29.9%) in participant recruitment. A total of 111 responses from 28 countries were collected during follow-up. Surgeons described policy and circumstantial changes that facilitated resumption of clinical work. CONCLUSIONS The COVID-19 pandemic and its related counter measures have had significant impacts on pediatric orthopaedic practice and increased uptake of technology to provide care continuity. Rigorous epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.
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Affiliation(s)
- Marissa Gibbard
- Departments of Orthopaedics
- BC Children’s Hospital Research Institute
| | - Ethan Ponton
- Departments of Orthopaedics
- Office of Pediatric Surgical Evaluation and Innovation, BC Children’s Hospital, University of British Columbia
| | | | - Sarah Farrell
- Department of Orthopaedics, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Jeffrey N. Bone
- Obstetrics and Gynaecology
- BC Children’s Hospital Research Institute
| | - Luke A. Wu
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Emily Schaeffer
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Anthony Cooper
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children
- Lilavati Hospital and Research Centre, Mumbai, India
| | - Kishore Mulpuri
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
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Melander S, Almström J, Enlund G, Frykholm P. The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery. Paediatr Anaesth 2021; 31:846-853. [PMID: 33971054 PMCID: PMC8242453 DOI: 10.1111/pan.14203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID-19 pandemic in Sweden. METHODS For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery. RESULTS We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near-normal levels by the end of June 2020. CONCLUSION We conclude that the impact of COVID-19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.
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Affiliation(s)
- Sixten Melander
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Jimmy Almström
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Gunnar Enlund
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Peter Frykholm
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
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Özbay H, Toy S, Polat O. The impact of Covid-19 pandemic related lockdown on clubfoot practice: Type of study design: Retrospective cross-sectional study. Medicine (Baltimore) 2021; 100:e26389. [PMID: 34160419 PMCID: PMC8238334 DOI: 10.1097/md.0000000000026389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT We investigated whether the number of pediatric patients with congenital clubfoot treated with the Ponseti method decreased during the Covid-19 pandemic or not in a rural area. So we aimed to guide orthopedic surgeons and health infrastructure for future pandemics to be prepared in hospitals of rural areas for the treatment of children with congenital clubfoot.One hundred and fifty-four patients with clubfoot who were admitted to our clinic were evaluated retrospectively from March 2017 to December 2020. Institutional hospital electronic database was used to detect the number of weeks between the birth and first cast performed in clinic and the number of casts been applied and unilaterality or bilaterality. Patients were divided into four groups, which included pandemic period and three previous years. Recorded data were analyzed statistically to detect if there is a difference between the numbers of the patients in pandemic period and three previous years.The number of patients with clubfoot admitted to our hospital between March 2020 and December 2020 increased by 140% compared to previous year. There was a statistically significant difference between the average number of cast applications of Group 4 and other groups (P <.001). Achilles tenotomy was performed in 44 (61.1%) of 72 patients admitted during the pandemic period. Only 4 (13.3%) out of 30 patients admitted between March 2019 and December 2019 were performed Achilles tenotomy.We detected an increase in the number of clubfoot cases admitted to our rural-based hospital during the Covid-19 pandemic, treated with casting or surgically. We think this is because of preventive measures during the pandemic, which caused parents could not reach urban for treatment.
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van Oudtshoorn S, Chiu KYC, Khosa J. Beware of the bicycle! An increase in paediatric bicycle related injuries during the COVID-19 period in Western Australia. ANZ J Surg 2021; 91:1154-1158. [PMID: 33905619 PMCID: PMC8222872 DOI: 10.1111/ans.16918] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Background In Western Australia, the media has reported on an increase in the purchasing, repairs and use of bicycles during the COVID‐19 period. The study aimed to investigate for a relationship in bicycle related injuries in the paediatric population during the time of COVID‐19 restrictions. Methods A retrospective study of the incident of motorized and non‐motorized bicycle related injuries and trauma presentations during the COVID‐19 ‘shutdown’ period from March to June 2020. Data were collected from the Emergency Department Information System, discharge summaries, operation and radiology reports. The data presented is from Perth Children's Hospital, the only tertiary paediatric hospital and the only referral centre for childhood trauma in the state of Western Australia. Participants were children aged 15 years and younger attending the emergency department (ED) at Perth Children's Hospital during the designated time period. The primary outcomes included total ED presentations, bicycle related presentations and bicycle related admissions during the COVID‐19 period. Results Bicycle related presentations to the ED increased by 42.7% over the COVID‐19 period from 1.4% to 3.0% of all children attending the ED. Children admitted to the hospital with bicycle related injuries or trauma increased by 48.7% from 76 to 113 children in comparison to the same period in 2019. Conclusion During the period of COVID‐19 restrictions, paediatric ED presentations decreased dramatically, but bicycle related injuries and trauma increased substantially. Safety equipment including helmets and protective gear should be worn for all children riding bicycles, and social distancing should be maintained.
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Affiliation(s)
- Sarah van Oudtshoorn
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kei Y C Chiu
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Japinder Khosa
- Paediatric Surgery Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Blum P, Putzer D, Liebensteiner MC, Dammerer D. Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery - A Systematic Review of the Current Literature. In Vivo 2021; 35:1337-1343. [PMID: 33910811 DOI: 10.21873/invivo.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The Coronavirus disease 2019 (COVID-19) has led to significant disruptions in various medical specialties. We herein aimed to provide a systematic review of the published literature on the impact by the Covid-19 pandemic on orthopaedic and traumatological care by focusing on the number of clinical visits, surgeries and reasons for consultation. MATERIALS AND METHODS The published literature was reviewed using PubMed. Of 349 studies published between December 1, 2019 and October 1, 2020, 36 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. October 1, 2020 was used as the concluding date of publication. RESULTS The number of elective visits declined by 50.0% to 74.0%. The number of emergency and trauma visits showed a decrease of 37.7% to 74.2%. Trauma surgery decreased by 21.2% to 66.7% and elective surgeries by 33.3% to 100%. CONCLUSION Orthopaedic and trauma surgery is clearly influenced by the pandemic. It will be important to maintain treatment and surgical care of patients in order to avoid negative effects on treatment progress.
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Affiliation(s)
- Philipp Blum
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria;
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael C Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Ow ZGW, Cheong CK, Chin YH, Chin BZ. A look at the global impact of SARS CoV-2 on orthopedic services. J Clin Orthop Trauma 2021; 12:33-39. [PMID: 33191995 PMCID: PMC7648525 DOI: 10.1016/j.jcot.2020.10.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic profoundly impacted healthcare institutions worldwide. Particularly, orthopedic departments had to adapt their operational models. PURPOSE This review aimed to quantify the reduction in surgical and outpatient caseloads, identify other significant trends and ascertain the impact of these trends on orthopedic residency training programs. METHODS Medline and Embase were searched for articles describing case load for surgeries, outpatient clinic attendance, or emergency department (ED) visits. Statistical analysis of quantitative data was performed after a Freeman-Tukey double arcsine transformation. Results were pooled with random effects by DerSimonian and Laird model. When insufficient data was available, a systematic approach was used to present the results instead. RESULTS A total of 23 studies were included in this study. The number of elective surgeries, trauma procedures and outpatient attendance decreased by 80% (2013/17400, 0.20, CI: 0.12 to 0.29), 47% (3887/17561, 0.53, CI: 0.37 to 0.69) and 63% (84174/123967, 0.37, CI: 0.24 to 0.51) respectively. During the pandemic, domestic injuries and polytrauma increased. Residency training was disrupted due to diminished clinical exposure and changing teaching methodologies. Additionally, residents had more duties which contributed to a lower quality of life. CONCLUSIONS The COVID-19 pandemic has made an unprecedented impact on orthopedics departments worldwide. The slow return of orthopedic departments to normalcy and the compromised training of residents due to the pandemic points to an uncertain future for healthcare institutions worldwide, wherein the impact of this pandemic may yet still be felt far in the future.
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Affiliation(s)
- Zachariah Gene Wing Ow
- Corresponding author. National University Health System, Singapore 1E Lower Kent Ridge Rd, Singapore, 119074
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Birsel SE, Sarıkaya İA, Şeker A, Erdal OA, Görgün B, İnan M. How the COVID-19 pandemic is affecting paediatric orthopaedic practice in Turkey. J Child Orthop 2020; 14:581-588. [PMID: 33343754 PMCID: PMC7740686 DOI: 10.1302/1863-2548.14.200174] [Citation(s) in RCA: 8] [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] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Changes to routine clinical approaches during the corona virus disease 2019 (COVID-19) pandemic are necessary to decrease the risk of infection in patients and healthcare providers. Because the treatment of many conditions is time sensitive, it is crucial to modify the management of paediatric orthopaedic cases by minimizing any subsequent morbidity. Our purpose was to describe the different measures and management strategies that have been applied by paediatric orthopaedic surgeons and to show how paediatric orthopaedic practice is affected in Turkey. METHODS All active practicing members of the Turkish Society of Children's Orthopedic Surgery (TSCOS) were contacted via telephone and asked to fill out a survey (24 questions). For participants, either an email or web link was sent to their mobile phones. An online survey generator was used. RESULTS A total of 54 survey responses were collected, for a response rate of 55%. In all, 62% reported a 75% decrease in their outpatient frequency, whilst 75% reported a 75% decrease in their surgery frequency. A total of 86% of the performed surgeries were emergency cases. None of the participants performed elective surgeries, and 61% did not have the consent form specific to COVID. Choice of protective measures have changed considerably; 96% stated that they needed an algorithm to follow for situations such as pandemic. CONCLUSION This national survey revealed that the COVID-19 pandemic has had a detrimental effect on paediatric orthopaedic practice and practitioner response varies in terms of reactions and precautions. The necessity of creating a protocol based on what we have learned must be taken into consideration. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Sema Ertan Birsel
- Atlas University, Istanbul Medicine Hospital, Department of Orthopaedics and Traumatology, Bağcılar, Istanbul, Turkey
| | - İlker Abdullah Sarıkaya
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey,Correspondence should be sent to İlker Abdullah Sarıkaya, Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey. E-mail:
| | - Ali Şeker
- Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Kocamustafapasa, Istanbul, Turkey
| | - Ozan Ali Erdal
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Barış Görgün
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Muharrem İnan
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
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24
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Abstract
BACKGROUND The COVID-19 pandemic has substantially altered the typical process around performing surgery to ensure protection of health care workers, patients, and their families. One safety precaution has been the implementation of universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines the results of universal screening on children undergoing orthopaedic surgery. METHODS This is a retrospective cohort study evaluating the incidence and symptomatology of COVID-19 in all patients presenting for orthopaedic surgery at 3 pediatric tertiary care children's hospitals during the COVID-19 pandemic (March to June 2020). All patients underwent universal screening with a nasopharyngeal swab to detect presence of SARS-CoV-2. Bivariate and multivariate logistic regression analysis was performed to identify risk factors for positive COVID-19 screening. RESULTS In total, 1198 patients underwent preoperative screening across all 3 institutions and 7 (0.58%) had detection of SARS-CoV-2. The majority of patients (1/7, 86%) were asymptomatic. Patients that tested positive were significantly more likely to be Hispanic (P=0.046) and had greater number of medical comorbidities (P=0.013), as scored on the American Society of Anesthesiologists (ASA) physical status score. A known COVID-19 positive contact was found to be a significant risk factor in the multivariate analysis (P=0.004). CONCLUSIONS Early results of universal preoperative screening for COVID-19 demonstrates a low incidence and high rate of asymptomatic patients. Health care professionals, especially those at higher risk for the virus, should be aware of the challenges related to screening based solely on symptoms or travel history and consider universal screening for patients undergoing elective surgery. LEVEL OF EVIDENCE Level II.
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