Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the “golden weeks”

Abstract

Background and purpose — The COVID-19 pandemic has been recognised as an unprecedented global health crisis. This study assesses the impact on a large acute paediatric hospital service in London, evaluating the trends in the acute paediatric orthopaedic trauma referral caseload and operative casemix before (2019) and during (2020) COVID-19 lockdown. Patients and methods — A longitudinal retrospective observational prevalence study of both acute paediatric orthopaedic trauma referrals and operative caseload was performed for the first 6 “golden weeks” of lockdown. These data were compared with the same period in 2019. Statistical analyses included median (± median absolute deviation), risk and odds ratios as well as Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05. Results — Acute paediatric trauma referrals in 2020 were reduced by two-thirds compared with 2019 (n = 302 vs. 97) with a halving risk (RR 0.55) and odds ratios (OR 0.43) of sporting-related mechanism of injuries (p = 0.002). There was a greater use of outpatient telemedicine in the COVID-19 period with more Virtual Fracture Clinic use (OR 97, RR 84, p < 0.001), and fewer patients being seen for consultation and followed up face to face (OR 0.55, RR 0.05, p < 0.001). Interpretation — The impact of the COVID-19 pandemic has led to a decline in the number of acute paediatric trauma referrals, admissions, and operations during the COVID period. There has also been a significant change in the patient pathway with more being reviewed via the means of telemedicine to reduce the risk of COVID-19 transmission and exposure. More work is required to observe for similar trends nationwide and globally as the pandemic has permanently affected the entire healthcare infrastructure.

The global burden of trauma during the COVID-19 pandemic: A scoping review

“…An increase in injuries from RTCs in children was reported by Bram et al in the US (5.2% v 1.8%) 11 and UK by Sugand et al (2% v 1%). 61 Further increases were reported in centres in the US by Lubbe et al (12.9% v 10.9%), 32 and in Italy by Giuntoli et al (21.6% v 19.3%). 30 …”

“…This was particularly prevalent in the paediatric proportion, as reported by Bram et al (33.7% v 21.7%) 25 and Sugand et al in the UK (6% v 3%). 61 Further increases in falls from height were reported in the spinal department in Italy (55.6% v 16.7%), 22 Australia (12.3% v 11.6%, 0.83) 31 , India (25% v 13.5%), 53 the UK (17.4% v 12.4%). 10 …”

“… 57 A significant increase was also shown in Rhodes et al‘s US centre (0.77% v 0.1%, p = 0.025), Jacob et al in Australia (35.1% v 34.9%, p = 0.02) 51 and Dhillon's centre in India (20% vs 5.49%). 53 Smaller increases were reported in the UK, 20 Australia 50 , 61 and the US. 32 Reductions in the proportion of falls were reported by Staunton et al in Ireland (36% vs 45%), 33 Nabian et al in Iran (49.3% v 58.9%, p = 0.008) 37 , New Zealand 12 and centres in the UK 45 , 49 and US.…”

Responsive caregiving, opportunities for early learning, and children’s safety and security during COVID-19: A rapid review

“…Nine studies from eight countries reported a significant reduction in emergency department presentations and operations for injuries among children during government-imposed lockdown restrictions, especially related to admissions and operations for sporting-related injuries and those that occur on playgrounds bans on sports and access to playgrounds [107–115]. For example, a study based on data from a large acute paediatric hospital in London, UK, found that the prevalence of referrals for child injuries was reduced by nearly two-thirds during the lockdown from 17 March to 28 April 2020, compared to in the same period in 2019 [111]. In contrast, some centres found a relative increase in injuries, including bicycle injuries [107, 109], burn injuries [116], ingestions and poisonings [108], and electrical injuries [114].…”

Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

“…One study reported reduction in paediatric admissions for acute asthma at a London teaching hospital, with suggested reasons including distancing from peers leading to reduced transmissions of respiratory viruses [14]. There are also reports of reduced trauma surgeries as road traffic accidents and sporting injuries were less prevalent during the pandemic [15]. There are concerns that the COVID-19 pandemic will increase levels of antimicrobial resistance in part due to relaxing of antimicrobial stewardship activities [16].…”