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Delbrück H, Lambertz E, Migliorini F, Berger N, Hildebrand F. Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review. Eur J Trauma Emerg Surg 2024; 50:591-601. [PMID: 38286949 PMCID: PMC11035450 DOI: 10.1007/s00068-024-02453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE The study investigates changes in the injury characteristics of hospitalised children in a paediatric trauma centre during the COVID-19 pandemic. METHODS Data from injured children from the pre-pandemic year 2019 were compared to the pandemic year 2020 using Pearson's chi-squared test and the Mann-Whitney U test. The period of highly restrictive regulations (HRP) was evaluated separately. A comprehensive literature review with defined search terms resulted in a descriptive data synthesis. RESULTS Data from 865 patients indicated reductions in admissions of 5.6% and 54.4% during the HRP. In 2020, the hospitalisation time was longer (2.2 ± 2.7 days in 2019 vs. 2.4 ± 2.6 in 2020, p = 0.045); the proportions of wounds requiring surgical therapy (p = 0.008) and of observational treatments, primarily for mild brain injuries (p = 0.046), were higher; and conservative treatments, primarily for contusions, were lower (p = 0.005). There were no significant changes in age, location of lesions, or frequency of surgical therapy; nor were there differences in the HRP, except for fewer injuries in school and kindergarten (p < 0.001). The literature review summarises the main results of 79 studies. CONCLUSION Limited resources did not alter the indications for surgical therapy. Further studies should examine whether the more common injuries sustained at home were caused by excessive work/childcare demands on parents. Reduced inpatient conservative treatment implies that hospital resources possibly were overused previously. The literature offers answers to many detailed questions regarding childhood injuries during a pandemic and more efficient safe treatment. Registration Ethical committee of RWTH Aachen University EK 22-320; Center for Translational & Clinical Research RWTH Aachen University (CTC-A) 21-430.
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Affiliation(s)
- Heide Delbrück
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Ellen Lambertz
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Nina Berger
- Department of Neuromuscular and Paediatric Orthopaedics, Klinikum Dritter Orden München - Nymphenburg, Menzinger Strasse 44, 80638, München, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
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Flury T, Gerber J, Anwander H, Müller M, Jakob DA, Exadaktylos A, Klingberg K. Who was at risk of trauma-related injuries during the COVID-19 pandemic? A retrospective study from a level 1 trauma centre in Switzerland. Swiss Med Wkly 2024; 154:3539. [PMID: 38579330 DOI: 10.57187/s.3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION During the first wave of the COVID-19 pandemic, increasingly strict restrictions were imposed on the activities of the Swiss population, with a peak from 21 March to 27 April 2020. Changes in trauma patterns during the pandemic and the lockdown have been described in various studies around the world, and highlight some particularly exposed groups of people. The objective of this study was to assess changes in trauma-related presentations to the emergency department (ED) during the first wave of the COVID-19 pandemic, as compared to the same period in the previous year, with a particular focus on vulnerable populations. MATERIALS AND METHODS All trauma-related admissions to our ED in the first half of 2019 and 2020 were included. Patient demographics, trauma mechanism, affected body region, injury severity and discharge type were extracted from our hospital information system. Trauma subpopulations, such as interpersonal violence, self-inflicted trauma, geriatric trauma and sports-related trauma were analysed. RESULTS A total of 5839 ED presentations were included in our study, of which 39.9% were female. Median age was 40 years (interquartile range: 27-60). In comparison to 2019, there was a 15.5% decrease in trauma-related ED presentations in the first half of 2020. This decrease was particularly marked in the 2-month March/April period, with a drop of 36.8%. In 2020, there was a reduction in injuries caused by falls of less than 3 metres or by mechanical force. There was a marked decrease in sports-related trauma and an increase in injuries related to pedal cycles. Geriatric trauma, self-harm and assault-related injuries remained stable. CONCLUSION This study described changes in trauma patterns and highlighted populations at risk of trauma during the pandemic in Switzerland in the context of previous international studies.These results may contribute to resource management in a future pandemic.
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Affiliation(s)
- Till Flury
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Gerber
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karsten Klingberg
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zayat MN, Griend MV, Flesher N, Lightwine K, Ablah E, Okut H, Haan JM. Falls Among Older Adults During the COVID-19 Pandemic Compared to a Pre-pandemic Period: A Case-Control Study. Am Surg 2023; 89:5988-5995. [PMID: 37285470 PMCID: PMC10251062 DOI: 10.1177/00031348231180919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic impacted older adults admitted to the hospital with fall-related injuries. This research sought to determine if there was a difference in patient characteristics and hospital outcomes among older adults with fall-related injuries during the COVID-19 pandemic compared to a non-pandemic period. METHODS A retrospective chart review of patients 65 years or older admitted for traumatic falls before and during COVID-19 was undertaken. Data abstracted included demographics, fall details, injury data, and hospital course. RESULTS Of 1598 patients, 50.5% presented during COVID-19 (cases), and 49.5% presented pre-pandemic (controls). Fewer cases fell in rural areas (28.6% vs 34.1%, P = .018) and were transferred from outside hospitals (32.1% vs 38.2%, P = .011). More cases experienced alcohol (4.6% vs 2.4%, P = .017) and substance use disorders (1.4% vs .4%, P = .029). Fewer cases had subdural hemorrhages (11.8% vs 16.4%, P = .007), and more had pneumothoraxes (3.5% vs 1.8%, P = .032). More patients admitted during COVID-19 experienced acute respiratory failure (2.0% vs .0%, P < .001), hypoxia (1.5% vs .3%, P = .005), and delirium (6.3% vs 1.0%, P < .001). Fewer cases were discharged to skilled nursing facilities (50.8% vs 57.3%, P = .009) and more to home with services (13.1% vs 8.3%, P = .002). DISCUSSION This study suggested there was a similar frequency of presentation for falls among older adults during the two study periods. Older adults with fall-related injuries experienced differences in presenting comorbidities, injury patterns, complications, and discharge locations during the study periods.
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Affiliation(s)
- Marisa-Nicole Zayat
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Micah Vander Griend
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Nathan Flesher
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Kelly Lightwine
- Departments of Trauma Services, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA
| | - Elizabeth Ablah
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Hayrettin Okut
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - James M. Haan
- Department of Population Health, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA
- Departments of Trauma Services, Ascension Via Christi Hospital Saint Francis, Wichita, KS, USA
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He LD, Duggan JL, Lans J, Harper CM, Rozental TD. Trends in Orthopedic Management of Distal Radius Fractures Among Medicare Beneficiaries From 2019 to 2020: A Claims Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:717-721. [PMID: 38106940 PMCID: PMC10721538 DOI: 10.1016/j.jhsg.2023.06.002] [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: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Radius and ulna fractures are among the most common fractures. These fractures are managed through operative or nonsurgical treatment, with varying implications in terms of cost and functional outcome. There are few studies that robustly characterize the management of distal radius fractures (DRFs) in the United States during the COVID-19 pandemic. Furthermore, this has not been studied among the Medicare patient population, who are particularly vulnerable to fragility fractures and COVID-19. The purpose of this study is to analyze the services provided to Medicare beneficiaries both before and during the COVID-19 pandemic to determine how procedure volume was affected in this patient population. Methods We retrospectively analyzed services using the physician or supplier procedure summary data from the Centers for Medicare and Medicaid Services. All services provided by physicians between January 1, 2019, and December 31, 2020, were included. The data were stratified by US census region using insurance carrier number and pricing locality codes. We also compared data between states that maintained governors affiliated with the Democratic or Republican parties for the duration of the study. Results There was an overall decrease in claims regarding DRFs management from 2019 to 2020. There was a dramatic decline in procedure volume (-6.3% vs -12.9%). Of all distal radius related claims there was a relative increase in the proportion of operatively managed DRFs in 2020, from 50.2% to 52.0%. The Midwest saw the greatest decline in operatively managed DRFs, whereas the West experienced the smallest per-capita decline across all procedures. After separating the data by party affiliation, it was also found that operative and nonsurgical procedure volumes fell more sharply in states with Democratic governors. Conclusions This study shows a decrease in DRF procedural volume among Medicare beneficiaries. This data suggests that the operative and nonsurgical management of DRFs may have been affected by pandemic factors such as quarantine guidelines and supply chain or resource limitations. This may assist surgeons and health care systems in predicting how similar crises may affect operative volume. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | | | - Jonathan Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Carl M. Harper
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara D. Rozental
- Division of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Morello V, Zingg M, Andereggen E, Ansorge A, Valisena S, Gamulin A. High-energy blunt pelvic ring injury incidence and polytrauma caseload in a single level I trauma center during COVID-19 related pseudo-lockdown measures: a retrospective cohort study based on a prospective registry. Eur J Med Res 2023; 28:325. [PMID: 37684644 PMCID: PMC10486067 DOI: 10.1186/s40001-023-01313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Pelvic ring injuries are potentially lethal lesions associated with polytrauma patients and need an efficient trauma team for their management. The purpose of this study was to evaluate the incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients in a single level I trauma center during the 2020 pseudo-lockdown period related to the Coronavirus pandemic, and to compare it with corresponding periods in 2014-2019 in order to better understand the need of organized and dedicated personnel and infrastructures. METHODS This retrospective cohort study was based on data prospectively recorded into the institutional Severely Injured Patients' Registry. Data were obtained for each year period (January 1st to December 31st) and corresponding pseudo-lockdown period (March 16th to June 19th). High-energy blunt pelvic ring injuries inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) pelvic ring injury presence. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; (3) penetrating, blast, burn and electrical injuries, drownings; (4) patients living outside the defined institution's catchment area; and (5) any document attesting the patient's will to not participate in any study. Polytrauma patients inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) Injury Severity Score ≥ 16. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; and (3) any document attesting the patient's will to not participate in any study. Categorical variables were reported using proportions and continuous variables using medians and interquartile ranges. Because data were exhaustive for the authors' level I trauma center, no inferential statistics were computed. RESULTS The incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients remained within range of previous years despite pseudo-lockdown measures. CONCLUSIONS These observations bring better knowledge about pseudo-lockdown's impact on trauma and may help for future health strategy planning by pointing out the importance of maintaining the activity of level I trauma centers in terms of personnel and infrastructures.
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Affiliation(s)
- Vanessa Morello
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Elisabeth Andereggen
- Division of Emergency Medicine, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Alexandre Ansorge
- Division of Emergency Medicine, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Silvia Valisena
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland.
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Jojczuk M, Pawlikowski J, Kamiński P, Głuchowski D, Naylor K, Gajewski J, Karpiński R, Krakowski P, Jonak J, Nogalski A, Czerwiński D. Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness. Healthcare (Basel) 2023; 11:2436. [PMID: 37685470 PMCID: PMC10486767 DOI: 10.3390/healthcare11172436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.
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Affiliation(s)
- Mariusz Jojczuk
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Jakub Pawlikowski
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Piotr Kamiński
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Dariusz Głuchowski
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, University of Technology, 20-618 Lublin, Poland; (D.G.)
| | - Katarzyna Naylor
- Independent Unit of Emergency Medical Services and Specialist Emergency, Medical University of Lublin, Chodzki 7, 20-093 Lublin, Poland
| | - Jakub Gajewski
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-439 Lublin, Poland
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland; (J.G.)
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland; (M.J.); (P.K.); (A.N.)
| | - Dariusz Czerwiński
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, University of Technology, 20-618 Lublin, Poland; (D.G.)
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Franco VP, Gonçalves GM, Fração OC, Sungaila HYF, Cocco LF, Dobashi ET. EVALUATION OF THE EPIDEMIOLOGY OF EXPOSED FRACTURES BEFORE AND DURING THE COVID-19 PANDEMIC. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268179. [PMID: 37547240 PMCID: PMC10399993 DOI: 10.1590/1413-785220233104e268179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/17/2023] [Indexed: 08/08/2023]
Abstract
Objective To assess the impact of the COVID-19 pandemic on the epidemiology and clinical outcomes of open fractures considering the periods before and during the pandemic. Methods An observational and retrospective study, which included patients aged over 18 years, admitted to the Orthopedics and Traumatology Ward of Hospital São Paulo, of the Federal University of São Paulo (UNIFESP). Data was collected in two moments: pre-pandemic (March 1, 2019, to February 29, 2020) and during the pandemic (March 1, 2020, to February 28, 2021). Results In total, 183 patients were evaluated with a mean age of 36 years ± 14 years. In the pre-pandemic period, 94 patients underwent surgery, 81 men (85.37%) and 13 women (14.2%), with a mean age of 36 ± 3 years. During the pandemic period, 89 patients were subjected to surgery, 77 men (86.6%) and 12 women (13.4%), with a mean age of 38 ± 3 years. Conclusion During the pandemic, open fractures were still more common in men. Regarding hospital indicators, the prevalence of infections in the surgical wound and the length of stay of patients with open fractures increased, however, with little significance. Fractures classified as Gustilo IIIA were the most common, while the most common according to the AO classification were 33, 34, 42, 43, 2R3, and 2R3 + 2U2. The frequency of run overs during the pandemic decreased. However, firearm projectile injuries and falls and occupational injuries increased. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Vinicius Pagliaro Franco
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Gabriel Massarico Gonçalves
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Orlando Copetti Fração
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Heloisa Yumi Fujiya Sungaila
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Luiz Fernando Cocco
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Eiffel Tsuyoshi Dobashi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, Serviço de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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Sammut-Powell C, Williams R, Sperrin M, Thomas O, Peek N, Grant SW. Healthcare utilisation in patients with long-term conditions during the COVID-19 pandemic: a population-based observational study of all patients across Greater Manchester, UK. BMJ Open 2023; 13:e066873. [PMID: 37419643 PMCID: PMC10335594 DOI: 10.1136/bmjopen-2022-066873] [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: 09/07/2022] [Accepted: 02/15/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Data on population healthcare utilisation (HCU) across both primary and secondary care during the COVID-19 pandemic are lacking. We describe primary and secondary HCU stratified by long-term conditions (LTCs) and deprivation, during the first 19 months of COVID-19 pandemic across a large urban area in the UK. DESIGN A retrospective, observational study. SETTING All primary and secondary care organisations that contributed to the Greater Manchester Care Record throughout 30 December 2019 to 1 August 2021. PARTICIPANTS 3 225 169 patients who were registered with or attended a National Health Service primary or secondary care service during the study period. PRIMARY OUTCOMES Primary care HCU (incident prescribing and recording of healthcare information) and secondary care HCU (planned and unplanned admissions) were assessed. RESULTS The first national lockdown was associated with reductions in all primary HCU measures, ranging from 24.7% (24.0% to 25.5%) for incident prescribing to 84.9% (84.2% to 85.5%) for cholesterol monitoring. Secondary HCU also dropped significantly for planned (47.4% (42.9% to 51.5%)) and unplanned admissions (35.3% (28.3% to 41.6%)). Only secondary care had significant reductions in HCU during the second national lockdown. Primary HCU measures had not recovered to prepandemic levels by the end of the study. The secondary admission rate ratio between multi-morbid patients and those without LTCs increased during the first lockdown by a factor of 2.40 (2.05 to 2.82; p<0.001) for planned admissions and 1.25 (1.07 to 1.47; p=0.006) for unplanned admissions. No significant changes in this ratio were observed in primary HCU. CONCLUSION Major changes in primary and secondary HCU were observed during the COVID-19 pandemic. Secondary HCU reduced more in those without LTCs and the ratio of utilisation between patients from the most and least deprived areas increased for the majority of HCU measures. Overall primary and secondary care HCU for some LTC groups had not returned to prepandemic levels by the end of the study.
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Affiliation(s)
- Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health Research Applied Research Collaboration Greater Manchester, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Richard Williams
- Division of Informatics, Imaging and Data Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health Research Applied Research Collaboration Greater Manchester, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | | | - N Peek
- Division of Informatics, Imaging and Data Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health Research Applied Research Collaboration Greater Manchester, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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Côté-Corriveau G, Luu TM, Lewin A, Brousseau É, Ayoub A, Blaser C, Auger N. Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic. CHILD ABUSE & NEGLECT 2023; 140:106186. [PMID: 37060690 PMCID: PMC10080276 DOI: 10.1016/j.chiabu.2023.106186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/13/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated. OBJECTIVE We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries. PARTICIPANTS AND SETTING This study included children aged 0-4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada. METHODS We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury. RESULTS Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1-23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7-19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000. CONCLUSIONS Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.
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Affiliation(s)
- Gabriel Côté-Corriveau
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Saint-Laurent, Quebec, Canada; Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Émilie Brousseau
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Christine Blaser
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
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10
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Auger N, Lewin A, Brousseau É, Ayoub A, Blaser C, Luu TM. Lockdowns and cycling injuries: temporal analysis of rates in Quebec during the first year of the pandemic. Health Promot Chronic Dis Prev Can 2023; 43:330-337. [PMID: 37466398 PMCID: PMC10414814 DOI: 10.24095/hpcdp.43.7.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Cycling increased in popularity during the COVID-19 pandemic, but the impact on cycling injuries is not known. We examined the effect of lockdowns on cycling injury hospitalizations. METHODS We identified hospitalizations for cycling injuries in Quebec, Canada, between April 2006 and March 2021. We used rate ratios (RR) and 95% confidence intervals (CI) to compare hospitalization rates by type of cycling injury and anatomical site during two waves of the pandemic. We performed interrupted time series regression to assess the effect of lockdowns on monthly cycling injury hospitalization rates, according to age, sex and other characteristics. RESULTS There were 2020 hospitalizations for cycling injuries between March 2020 and March 2021, including 617 during the first lockdown and 67 during the second lockdown. Compared with the period before the pandemic, risk of cycling-related injuries during the first lockdown increased the most for fractures (RR = 1.44; 95% CI: 1.26- 1.64) and head and neck injuries (RR = 1.59; 95% CI: 1.19-2.12). Cycling injury hospitalization rates increased significantly among adults, adolescents and individuals from socioeconomically advantaged neighbourhoods or those with low concentrations of racialized people every month of the first lockdown. The second lockdown was not associated with cycling injuries. CONCLUSION The first lockdown triggered a sharp increase in cycling injury hospitalizations, especially among adults, adolescents and individuals from socioeconomically advantaged and less racialized neighbourhoods.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Montréal, Quebec, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Christine Blaser
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, Université de Montréal, Montréal, Quebec, Canada
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11
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Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
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Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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VON-Bahten LC, Zvicker AL, Silva AADA, Salviato BZ, Teixeira HM, Ando PK, Bernardelli RS. Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls. Rev Col Bras Cir 2023; 50:e20233422. [PMID: 36921132 PMCID: PMC10519699 DOI: 10.1590/0100-6991e-20233422-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic. METHOD a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018. RESULTS a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period. CONCLUSIONS there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.
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Affiliation(s)
- Luiz Carlos VON-Bahten
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
| | - Aliana Lunardi Zvicker
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Angel Adriany DA Silva
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | - Heloísa Moro Teixeira
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Paula Kaori Ando
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Rafaella Stradiotto Bernardelli
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Bioestatística - Curitiba - PR - Brasil
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Ojima M, Ishida K, Katayama Y, Hirose T, Nakao S, Tachino J, Noda T, Umemura Y, Kiguchi T, Kiyohara K, Matsuyama T, Kitamura T, Oda J, Ohnishi M. Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study. Acute Med Surg 2023; 10:e817. [PMID: 36698916 PMCID: PMC9849826 DOI: 10.1002/ams2.817] [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: 09/09/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
Aim The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients. Methods Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020. Results In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020. Conclusion This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.
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Affiliation(s)
- Masahiro Ojima
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka Metropolitan University School of MedicineOsakaJapan
| | - Yutaka Umemura
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical CareOsaka General Medical CenterOsakaJapan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home EconomicsOtsuma Women's UniversityTokyoJapan
| | - Tasuku Matsuyama
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Mitsuo Ohnishi
- Department of Acute Medicine and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
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VON-BAHTEN LUIZCARLOS, ZVICKER ALIANALUNARDI, SILVA ANGELADRIANYDA, SALVIATO BEATRIZZANUTTO, TEIXEIRA HELOÍSAMORO, ANDO PAULAKAORI, BERNARDELLI RAFAELLASTRADIOTTO. Influência da pandemia da COVID-19 no perfil epidemiológico do atendimento inicial de pacientes vítimas de quedas. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
RESUMO Objetivo: avaliar o perfil epidemiológico do trauma por quedas de mesmo nível (QMN) e quedas de nível elevado (QNE) durante a pandemia da COVID-19, realizar a comparação dos dados entre os níveis de restrição (bandeiras) e comparar com dados prévios à pandemia. Método: estudo transversal com amostragem probabilística de prontuários de pacientes com 18 anos ou mais admitidos na sala de emergência devido a quedas de junho de 2020 a maio de 2021. Foram avaliados dados epidemiológicos, como sexo, idade e lesões resultantes, além da bandeira vigente. Os três períodos de restrição foram comparados entre si e a proporção de atendimentos por quedas foi comparada com o período de dezembro de 2016 a fevereiro de 2018. Resultados: avaliou-se 296 atendimentos, sendo 69,9% vítimas de QMN e 30,1% de QNE. A média de idade foi 57,6 anos, sendo que 45,6% apresentavam idade superior a 60 anos. Sexo masculino predominou e 40,2% dos pacientes necessitaram internamento hospitalar. Durante a bandeira vermelha proporcionalmente ocorreram mais lesões em cabeça e pescoço (p=0,016), trauma em extremidades (p=0,015) e neurológico (p<0,001). Obteve-se uma média de 6,1, 6,3 e 5,2 atendimentos/dia durante a bandeira amarela, laranja e vermelha respectivamente. Ocorreu um aumento significativo da ocorrência de quedas quando comparado ao período prévio à pandemia. Conclusões: durante o período pandêmico, verificou-se uma redução absoluta de atendimentos de vítimas de quedas na bandeira mais restritiva. Porém, quando comparado ao período pré-pandêmico, verifica-se um aumento significativo das quedas.
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Affiliation(s)
- LUIZ CARLOS VON-BAHTEN
- Hospital Universitário Cajuru, Brasil; Universidade Federal do Paraná, Brazil; Pontifícia Universidade Católica do Paraná, Brazil
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Colcuc C, Fischer S, Leimkühler P, Miersbach M, Lefering R, DGU T, Wähnert D, Vordemvenne T, Grüneweller N. Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU ®. J Clin Med 2022; 11:jcm11237036. [PMID: 36498614 PMCID: PMC9737013 DOI: 10.3390/jcm11237036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care.
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Affiliation(s)
- Christian Colcuc
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Philipp Leimkühler
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Marco Miersbach
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 51109 Cologne, Germany
| | - TraumaRegister DGU
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), 10623 Berlin, Germany
| | - Dirk Wähnert
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Thomas Vordemvenne
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
- Correspondence:
| | - Niklas Grüneweller
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
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Rosen B, Pelle AL, Lakhi NA. Impact of the COVID-19 Pandemic on Trauma Service Utilization at a New York City Level I Trauma Center. Pragmat Obs Res 2022; 13:93-103. [PMID: 36092688 PMCID: PMC9462934 DOI: 10.2147/por.s378189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic globally impacted trauma facilities and overall healthcare utilization. This study was conducted to characterize the utilization of trauma services at our Level I Trauma Center in New York City during the COVID-19 pandemic compared to the preceding pre-pandemic year. Methods A retrospective study of patient presenting to our Level 1 Trauma Center in Staten Island, New York. The pre-pandemic data was extracted from March 1st, 2019–February 29th, 2020. The pandemic year was divided into two phases: the initial wave (March 1st–Sept 1st, 2020) and the protracted phase (September 1st, 2020–March 1st, 2021). Patients were identified using ICD-10 coding and data regarding patient factors, mechanism of injury, and service utilization was extracted from the medical record. Statistical analysis was performed using IBM SPSS v.24. Results A total of 1650 trauma activations registered during the pre-pandemic phase, 691 during the initial wave, and 826 during the protracted phase. Compared to pre-pandemic, the number of Level 1 trauma activations remained unchanged, however mechanisms of injury shifted. Gunshot wounds (2.6% vs 1.2%), motorcycle crash (4.2% vs 2.0%) and blunt force injury caused by an object (strike injuries) (2.7% vs 1.3%) significantly increased during the initial wave (p-value <0.05). There was a significant decrease in the percentage of both female (2.93% vs 2.33% vs 5.64%, p-value <0.01) and pediatric (3.30% vs 3.64% vs 12.9%, p-value <0.001) assault activations during the initial wave and protracted phase when compared to pre-pandemic levels, respectively. No significant changes were observed for self-harm, falls, accidents, burns, sports injuries, stab wounds, autobody collisions, or motor vehicle accident activations. Conclusion Trauma centers should be prepared for increases in violent trauma. We also emphasize the need to implement strategies to raise public awareness of pediatric and female assault in the domestic setting, particularly during a mandatory stay-at-home policy where underreporting may occur.
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Affiliation(s)
- Benjamin Rosen
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, New York, USA
| | - Annemarie L Pelle
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, New York, USA
| | - Nisha A Lakhi
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, New York, USA.,Department of Trauma Surgery, Richmond University Medical Center, Staten Island, New York, USA
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Moreland B, Ortmann N, Clemens T. Increased unintentional drowning deaths in 2020 by age, race/ethnicity, sex, and location, United States. JOURNAL OF SAFETY RESEARCH 2022; 82:463-468. [PMID: 36031277 PMCID: PMC9418042 DOI: 10.1016/j.jsr.2022.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, one study in Australia showed an increase in drowning deaths in certain settings, while a study in China showed a decrease in drowning deaths. The impact of the COVID-19 pandemic on drowning deaths in the United States is unknown. OBJECTIVE To report on unintentional drowning deaths among U.S. persons aged ≤29 years by demographic characteristics and compare 2020 fatal drowning rates with rates from 2010 to 2019. METHODS Data from CDC WONDER were analyzed to calculate unintentional drowning death rates among persons aged ≤29 years by age group, sex, race/ethnicity, and location of drowning. These rates were compared to drowning death rates for the previous 10 years (2010-2019). RESULTS In 2020, 1.26 per 100,000 persons aged ≤29 years died from unintentional drowning, a 16.79% increase from 2019. Drowning death rates decreased 1.81% per year on average (95% CI: -3.02%, -0.59%) from 2010 to 2019. The largest increases in unintentional drowning deaths from 2019 to 2020 occurred among young adults aged 20 to 24 years (44.12%), Black or African American persons (23.73%), and males (19.55%). The location with the largest increase in drowning was natural water (26.44%). CONCLUSION Drowning death rates among persons aged ≤29 years significantly increased from 2019 to 2020. Further research is needed to understand the impacts of the COVID-19 pandemic on drowning and identify how drowning prevention strategies can be adapted and strengthened. PRACTICAL APPLICATIONS Drowning remains a leading cause of injury death among persons aged ≤29 years. However, drowning is preventable. Interventions such as learning basic swimming and water safety skills, and consistent use of lifejackets on boats and among weaker swimmers in natural water, have the potential to reduce drowning deaths. Developing strategies that ensure equitable access to these interventions may prevent future drowning.
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Affiliation(s)
- Briana Moreland
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States; Cherokee Nation Operational Solutions, United States.
| | - Neil Ortmann
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States; Oak Ridge Institute for Science and Education, United States
| | - Tessa Clemens
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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Increased Rate of Fracture Injuries Associated With Alternative Modes of Transportation During COVID-19. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00012. [PMID: 36166200 PMCID: PMC9519138 DOI: 10.5435/jaaosglobal-d-22-00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
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19
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Yoon JS, Khoo KH, Akhavan AA, Lagziel T, Ha M, Cox CA, Blanding R, Werthman EH, Caffrey J, Hultman CS. Changes in Burn Surgery Operative Volume and Metrics due to COVID-19. J Burn Care Res 2022; 43:1233-1240. [PMID: 35986489 PMCID: PMC9384663 DOI: 10.1093/jbcr/irac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to COVID-19, hospitals underwent drastic changes to operating room policy to mitigate the spread of the disease. Given these unprecedented measures, we aimed to look at the changes in operative volume and metrics of the burn surgery service at our institution. A retrospective review was conducted for operative cases and metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. Case types and operative metrics were compared amongst the three time periods. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (p < .0001 and p < .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (p < .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p < .01). COVID-19 related operating room closures led to an expected decrease in the number of operative cases. However, there was no significant decline in the number of burn specific cases. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.
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Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Arya A Akhavan
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Michael Ha
- Division of Plastic Surgery, University of Maryland School of Medicine , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Renee Blanding
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Emily H Werthman
- Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
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20
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Tse CY, Lee LHH, Akbari AR, Niazi NS, Pillai A. The Impact of COVID-19 Restrictions and Changes in Guidelines on Adult Wrist Fracture Management. J Wrist Surg 2022; 11:322-329. [PMID: 35971468 PMCID: PMC9375687 DOI: 10.1055/s-0041-1736608] [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: 08/02/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic had an unprecedented impact on the healthcare service of the United Kingdom. This study aims to evaluate the effect on wrist fracture care as a result of the COVID-19 pandemic, changes in British Orthopaedic Association Standards of Trauma and Orthopaedics wrist fracture management guidelines, and introduction of lockdown restrictions. Methods This is a retrospective observational study with data collected using the Pathpoint eTrauma platform (Open Medical, United Kingdom). All adults (18 years + ) admitted with wrist fractures within the study phases to Manchester University National Health Service Foundation Trust were included. Each phase of the study period represents a change in lockdown restrictions, including lockdown 1, period of eased restrictions after lockdown 1, lockdown 2, and lockdown 3. These phases were then compared with a prepandemic period. A total of 608 referrals were included for analysis. Results The number of referrals per week decreased from 9.94 prepandemic to as low as 8.12 during lockdown 2. Falls remained the most common mechanism of injury, followed by cycling that saw an increase by more than threefold from 2.42% prepandemic to 8.17% ( p = 0.500) during lockdown 1 and 8.77% ( p = 0.0164) during the easing of lockdown 1. Sports-related injuries and occupational injuries decreased throughout. Assaults and altercations, road traffic accidents, roller-skate, and skateboard-related injuries increased throughout. Surgical procedures per week decreased from 5.06 prepandemic to as low as 4.55 during lockdown 1. Procedure cancellations remained steady apart from an increase during lockdown 2. Referrals managed operatively increased from 50.9% prepandemic to 58.9% in lockdown 2, before dropping to 49.2% in lockdown 3. Mean time from presentation to surgery increased from 9.08 days prepandemic to 16.27 days in lockdown 1 but decreased to just below the prepandemic baseline thereafter. Conclusion Overall, there was a decrease in the number of wrist fracture referrals and surgical procedures compared with before the pandemic. There was also an increased wait-time to surgery and an increased rate of cancellations. Statistical analyses fail to find significance in changes other than mechanisms of injury, which resulted from lockdown restrictions. Therefore, service provision, delivery, and efficiency not affected significantly by changes in guidelines and lockdown restrictions.
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Affiliation(s)
- Cheuk Yin Tse
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lawrence Hin Hai Lee
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Amir Reza Akbari
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Noman Shakeel Niazi
- Department of Trauma and Orthopaedics, Manchester University NHS Foundation Trust, M23 9LT Wythenshawe Hospital, Manchester, United Kingdom
| | - Anand Pillai
- Department of Trauma and Orthopaedics, Manchester University NHS Foundation Trust, M23 9LT Wythenshawe Hospital, Manchester, United Kingdom
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21
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Duggleby L, Gourbault L, Parsons T, Boden E, Barton T, Giddins G. How many acute orthopaedic injuries are preventable? Injury 2022; 53:2790-2794. [PMID: 35676165 DOI: 10.1016/j.injury.2022.05.030] [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: 10/22/2021] [Revised: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Injury prevention is important. Injury as a result of an accident carries with it huge cost to the individual and society including health services costs. Understanding the mechanism of injury is important to identify those injuries that are preventable. The aim of this study was to assess how many acute orthopaedic injuries were preventable should reasonable human interventions have been taken METHODS: This prospective study was performed in a UK district general hospital that serves a population of 500,000 people. All patients referred to the Orthopaedic department over 4 weeks between 16th November and 14th December 2020 were reviewed. Data was collected about the mechanism of injury, patient demographics, injury type, injury location, treatment and length of stay in hospital. The mechanisms of injury were analysed thematically. RESULTS We assessed 605 patient attendances. 502 patients sustained 516 acute traumatic injuries. Preventable injuries were common, accounting for 23.9% of all referrals. The upper limb was most commonly injured with the hand and forearm being injured 33% of the time. Of the preventable injuries 35% were treated operatively. Thematic analysis identified common mechanisms of: occupational related, stairs, RTA, cycling, alcohol related, trampoline, DIY and assault. CONCLUSION This study identifies that a large proportion of acute orthopaedic injuries are potentially preventable meaning this is an important area for further study. Occupation injuries were identified as an area in which there is the greatest scope to reduce the number of preventable accidents.
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Affiliation(s)
| | | | | | | | | | - Grey Giddins
- Royal United Hospital, Combe Park, Bath BA1 3NG UK
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22
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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.
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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
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Stivaros S, Paddock M, Rajai A, Cliffe H, Connolly DJ, Dineen RA, Dixon R, Edwards H, Evans E, Halliday K, Jackson K, Landes C, Oates AJ, Stoodley N, Offiah AC. Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. Arch Dis Child 2022; 107:575-581. [PMID: 35177407 PMCID: PMC8882637 DOI: 10.1136/archdischild-2021-323444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/03/2022]
Abstract
Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown. OBJECTIVE To assess the number, type and outcome of radiological investigations for children presenting to hospital with suspected physical abuse (SPA; including abusive head trauma) during the first national COVID-19 enforced lockdown compared with the prelockdown period. DESIGN Multicentre, retrospective, observational, interrupted time series analysis. SETTING Eight secondary/tertiary paediatric centres between January 2018 and July 2020 inclusive. PARTICIPANTS 1587 hospital assessed children undergoing radiographic skeletal surveys (SkS) and head CT imaging performed for SPA/child protection concerns. MAIN OUTCOME MEASURES Incidence and severity of fractures identified on SkS; head injury (composed of incidence rates and ratios of skull fracture, intracranial haemorrhage (ICH) and hypoxic ischaemic injury (HII)) on head CT imaging; and ratio of antemortem and postmortem SkS. RESULTS 1587 SkS were performed: 1282 (81%) antemortem, 762 (48%) male, and positive findings in 582 (37%). Median patient age was 6 months. There were 1.7 fractures/child prelockdown versus 1.1 fractures/child during lockdown. There was no difference between positive/negative SkS rates, the absolute ratio of antemortem/postmortem SkS or absolute numbers of head injury occurring between January 2018 and February 2020 and the lockdown period April-July 2020. Likewise, prelockdown incidence and rates of skull fracture 30/244 (12%), ICH 28/220 (13%) and HIE 10/205 (5%) were similar to lockdown, 142/1304 (11%), 171/1152 (15%) and 68/1089 (6%), respectively. CONCLUSION The first UK COVID-19 lockdown did not lead to an increase in either the number of antemortem or postmortem radiological investigations performed for SPA, or the number or severity of fractures and intracranial injuries identified by these investigations.
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Affiliation(s)
- Stavros Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
| | - Michael Paddock
- Department of Medical Imaging, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Azita Rajai
- Centre for Biostatistics, Division of Population Health, Manchester Academic Science Centre, The University of Manchester, Manchester, UK
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Cliffe
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Daniel Ja Connolly
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Robert A Dineen
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Rachel Dixon
- Department of Paediatric Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Harriet Edwards
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Radiology, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Emily Evans
- Department of Radiology, University Hospital Coventry, Coventry, UK
| | - Katherine Halliday
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kandise Jackson
- Department of Radiology, Royal Oldham Hospital, Oldham, Greater Manchester, UK
| | - Caren Landes
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Adam J Oates
- Department of Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Neil Stoodley
- Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
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24
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Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study. Ann Med Surg (Lond) 2022; 77:103721. [PMID: 35531430 PMCID: PMC9065655 DOI: 10.1016/j.amsu.2022.103721] [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: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and method All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered. Results A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]). Conclusion This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine. Hospitalizations for cataract surgery, coronary angioplasty, hip and knee arthroplasties were strongly impacted by the pandemic from 2020 until the first half of 2021, without any catch-up outside the lockdown periods and despite the gradual rollout of the national COVID-19 vaccine campaign in 2021. Definitive cardiac stimulation was the only surgery not really impacted. Optimize surgical patient care in a pandemic setting and identify ways to improve the available capacity of surgical activity.
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25
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Flaherty DJ, Morgan C, Dela Cruz NJM, Morgan RV, Sarraf KM, Sinnett T, Roche A. Foot and ankle injuries related to the use of E-scooters - A case series and a review of literature. Foot (Edinb) 2022; 51:101873. [PMID: 35461150 DOI: 10.1016/j.foot.2021.101873] [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: 03/23/2021] [Revised: 07/22/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION As E-scooter use is increasing with the introduction of urban rental schemes in the United Kingdom, associated foot and ankle injuries will become more prevalent. The aim of this study is to assess the injury pattern and injury severity of foot and ankle trauma associated with E-scooter use. METHODS A retrospective case analysis of all E-scooter foot and ankle injuries presenting to three London hospitals between 1st January and 31st December 2020 was conducted. Data including demographics, mechanism and location of injury sustained, management, duration of hospital stay and mortality were collected. RESULTS 20 patients were identified with a total of 27 foot and ankle fractures. Eight patients had fracture dislocations, four sustained open injuries and 45% (9/20) of patients required surgical treatment. Those travelling over 15.5 mph were significantly more likely to require operative intervention (70%) than those travelling below 15.5 mph (20%) (P < 0.033) and were more likely to have an open fracture (40% compared to 0%) (P < 0.0886), however the latter was not of statistical significance. 85% (17/20) of rider's injuries involved the foot and/or ankle only. There were no mortalities at 30 days. CONCLUSIONS E-scooter use can cause serious foot and ankle injuries. Robust guidelines and legislation restricting top speeds and enforcing the wearing of protective clothing could be implemented. This may protect the E-scooter user from significant foot and ankle injury.
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Affiliation(s)
- David J Flaherty
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
| | - Catrin Morgan
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
| | - Nina Jyne Minette Dela Cruz
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
| | - Rebecca Verity Morgan
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
| | - Khaled M Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, W2 1NY, United Kingdom.
| | - Tim Sinnett
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
| | - Andrew Roche
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, United Kingdom.
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26
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da Silva AC, da Silva Santos G, Maluf EMCP, Borba VZC. Incidence of hip fractures during the COVID-19 pandemic in the Brazilian public health care system. Arch Osteoporos 2022; 17:42. [PMID: 35253090 PMCID: PMC8898593 DOI: 10.1007/s11657-022-01078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/12/2022] [Indexed: 02/03/2023]
Abstract
This study compared the incidence of hip fractures before and during the COVID-19 pandemic in Brazil, aged ≥ 60 years excluding all fractures related to any trauma. There was a significant reduction in the number of hip fractures and the length of hospital stay during the period of social isolation. PURPOSE To compare the incidence of hip fractures before and during the COVID-19 pandemic in Brazil and in the main regions of the country in patients covered by the Brazilian public health care system (SUS). As far as we are aware, no studies have evaluated the impact of COVID-19 pandemic on hip fractures in Brazil. METHODS Descriptive, cross-sectional study in individuals aged ≥ 60 years who presented with a hip fracture before and during the COVID-19 pandemic and received treatment covered by the SUS. The data were collected from the DATASUS electronic database. We calculated the incidence, mortality, lethality, duration of hospitalization, and average reimbursement associated with the treatment of the fractures. RESULTS There was a significant reduction in the incidence of hip fractures among individuals aged ≥ 60 years in Brazil during the period of social isolation due to COVID-19. The observed incidence was 15.58/10,000 inhabitants between March and December 2020 and 16.07/10,000 inhabitants in the same period of 2019 (p < 0.005; main decline observed in the age groups > 70 years). The average length of hospital stay reduced from 8.35 days in 2019 to 7.33 days in 2020, following a similar pattern of reduction across all regions. The Southeast was the only region with a significant reduction in mortality during the pandemic (relative risk 0.90, 95% confidence interval 0.84-0.97, p < 0.005). CONCLUSION During the COVID-19 pandemic in Brazil, the incidence rate of hip fractures and the associated duration of hospital stay decreased among patients aged ≥ 60 years.
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Affiliation(s)
| | | | | | - Victoria Zeghbi Cochenksi Borba
- Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Av. Agostinho Leão Júnior, 285–80030-110, Curitiba (Paraná), Brazil
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27
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Hodhody G, Lum JW, Afzal S, Mulgrew EV. The COVID CLAVICLE Study: A predictor of future trauma trends. JSES Int 2022; 6:362-367. [PMID: 35128502 PMCID: PMC8805908 DOI: 10.1016/j.jseint.2021.12.012] [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: 11/23/2022] Open
Abstract
Background Clavicle fractures are a common presentation to the emergency department after falls and sporting injuries. During 2020, the coronavirus disease 2019 (COVID-19) pandemic brought with it a long period of social isolation, resulting in a change of behavior patterns and, in return, the presentation of fractures to our local hospitals. The effects of this global pandemic on the presentation and management of clavicles were noted with particular interest to the change in mechanism and its future implications. Methods We performed a longitudinal observational study in 10 hospitals in the North West of England, reviewing all patients presenting with a clavicle fracture during 6 weeks in the first peak of COVID-19 pandemic and compared these with the same period in 2019. Collection points included the patient demographics, fracture characteristics, mechanism of injury, and management. Results A total of 427 clavicle fractures were assessed with lower numbers of patients presenting with a clavicle fracture during the COVID-2020 period (n = 177) compared with 2019 (n = 250). Cycling-related clavicle fractures increased 3-fold during the pandemic compared with the 2019 control group. We also noted an overall increase in clavicle fractures resulting from higher energy trauma as opposed to low energy or fragility fracture. We also found a faster time to surgery in the COVID cohort by 2.7 days on average when compared with 2019. Conclusions Government restrictions and the encouragement of social distancing led to behavioral changes with a vast increase in cyclists on the road. This created a significant rise in clavicle fractures related to this activity. This is likely to be further driven by the government pledge to double cyclists on the road by 2025 in the United Kingdom. We forecast that this increase in cyclists, a behavior change accelerated by the pandemic, is a reliable predictor for future trauma trends.
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Park J, Jung K, Kwon J, Moon J, Huh Y, Heo YJ, Kang BH. Changes in the characteristics of trauma patients after the early COVID-19 outbreak: A retrospective study of a regional level 1 trauma center in Republic of Korea. Medicine (Baltimore) 2022; 101:e28567. [PMID: 35029226 PMCID: PMC8758017 DOI: 10.1097/md.0000000000028567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023] Open
Abstract
Gyeonggi-do (Gyeonggi province) has the second highest number of coronavirus disease (COVID-19) cases in the Republic of Korea after Seoul, with approximately 25% of the COVID-19 patients as of January 2021. Our center is a level I trauma center located in south Gyeonggi-do, and we aimed to evaluate whether the characteristics of trauma patients changed after the COVID-19 pandemic.We retrospectively reviewed the trauma patients registered with the Korea Trauma Database of the Center from February 2019 to January 2021. The patients were dichotomized into pre-coronavirus disease (pre-COVID) and coronavirus disease (COVID) groups, and their trauma volumes, injury characteristics, intentionality, and outcomes were compared.A total of 2628 and 2636 patients were included in the pre-COVID and COVID groups, respectively. During the COVID-19 period, motorcycle accidents, bicycle accidents, and penetrating injury cases increased, and pedestrian traffic accidents, slips, and injury by machines decreased. The average daily number of patients in the COVID group was lower in March (5.6 ± 2.6/day vs 7.2 ± 2.4/day, P = .014) and higher in September (9.9 ± 3.2/day vs 7.7 ± 2.0/day, P = .003) compared to the pre-COVID group. The COVID group also had a higher ratio of direct admissions (67.5% vs 57.2%, P < .001), proportion of suicidal patients (4.1% vs 2.7%, P = .005), and injury severity scores (14 [9-22] vs 12 [4-22], P < .001) than the pre-COVID group. The overall mortality (4.7% vs 4.9%, P = .670) and intensive care unit length of stay (2 [0-3] days vs 2 [0-4] days, P = .153) was not different between the 2 groups.Although the total number of patients did not change, the COVID-19 pandemic affected the number of monthly admissions and the injury mechanisms changed. More severely injured patients were admitted directly to the trauma center.
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Affiliation(s)
- Jiye Park
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Junsik Kwon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yun Jung Heo
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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The effect of physical and social isolation due to the COVID-19 pandemic on the incidence of hip fractures among senior citizens. Geriatr Nurs 2021; 43:21-25. [PMID: 34798310 PMCID: PMC8531412 DOI: 10.1016/j.gerinurse.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022]
Abstract
This study aimed to explore the effects of the lockdown due to the coronavirus disease 2019 pandemic on the incidence and characteristics of hip fracture in older adults. Data from the three-month lockdown period and the corresponding period in the previous year were obtained from the computerized medical records of a large acute-care hospital. No significant differences were observed in the absolute and relative numbers of hip fractures. There were no significant differences in terms of socio-demographic and clinical characteristics, which are considered risk factors for falls. Similarly, there was no difference in the length of time between admission and surgery and the mean length of hospital stay. Compared to the previous year, there was a significantly higher incidence of hip fractures in older adults living alone during the lockdown. Health policy should provide social support and monitoring of healthcare, particularly to older adults living alone.
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30
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Effect of the COVID-19 Outbreak on Pediatric Patients' Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8080645. [PMID: 34438536 PMCID: PMC8394969 DOI: 10.3390/children8080645] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population during the pandemic was compared to a similar group of patients admitted to the ER in 2019. Sex, age, triage color-code at admission, cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The lockdown period led to a reduction of 87.0% in ER admissions with a particular decrease in patients older than 12 years old. Moreover, a trend towards more severe codes and an increase in home-related injuries were observed during the pandemic, whereas the diagnosis of fracture was less frequent in the pre-pandemic group (p < 0.0001). Conclusions: A significant decrease in the ER attendances was reported during the lockdown. A shift in the cause and type of injury was observed; only the most serious traumas sought medical care with a higher percentage of severe triage codes and fractures.
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