Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department

Luceri, Francesco; Morelli, Ivano; Accetta, Riccardo; Mangiavini, Laura; Maffulli, Nicola; Peretti, G.

doi:10.1186/s13018-020-01816-1

Cited by 58 publications

(59 citation statements)

References 17 publications

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“…There was a worldwide reduction of between 20.3% and 84.6% in trauma patients compared to a pre-COVID control period. 10 , 11 , 12 , 13 , 14 , 15 , 17 , 19 , 20 , 25 , 27 , 34 , 35 , 37 , 41 , 42 , 43 , 44 , 45 , 46 Hernigou et al 16 reported a concomitant increase in paediatric trauma and reduction in adult trauma during the pandemic at their centre in Belgium, a finding replicated in one Australian centre. 47 Additionally, Wong et al‘s centre based in Australia reported no change in paediatric trauma requiring acute admission.…”

Section: Resultsmentioning

confidence: 91%

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

Waseem

Nayar

Hull

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Purpose; The COVID-19 pandemic has necessitated profound adaptations in the delivery of healthcare to manage a rise in critically unwell patients. In an attempt to slow the spread of the virus nationwide lockdown restrictions were introduced. This review aims to scope the literature on the impact of the pandemic and subsequent lockdown on the presentation and management of trauma globally. Methods; A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was carried out on the Medline, EMBASE and Cochrane databases to identify papers investigating presentation and management of trauma during the COVID-19 pandemic. All studies based on patients admitted with orthopaedic trauma during the COVID-19 pandemic were included. Exclusion criteria were opinion-based reports, reviews, studies that did not provide quantitative data and papers not in English. Results; Three hundred and thirty seven studies were screened, with 17 meeting the eligibility criteria. Studies reported on the footfall of trauma in the UK, Europe, Asia, USA, Australia and New Zealand. A total of 29,591 patients during the pandemic were considered. Mean age was 43.7 years (range <1–103); 54.8% were male. Reported reductions in trauma footfall ranged from 20.3% to 84.6%, with a higher proportion of trauma occurring secondary to interpersonal violence, deliberate self-harm and falls from a height. A decrease was seen in road traffic collisions, sports injuries and trauma occurring outdoors. There was no significant change in the proportion of patients managed operatively, and the number of trauma patients reported to be COVID-19 positive was low. Conclusion; Whilst the worldwide COVID-19 pandemic has caused a reduction in the number of trauma patients; the services managing trauma have continued to function despite infrastructural, personnel and pathway changes in health systems. The substantial effect of the COVID-19 pandemic on elective orthopaedics is well described, however the contents of this review evidence minimal change in the delivery of effective trauma care despite resource constraints during this global COVID-19 pandemic.

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Section: Resultsmentioning

confidence: 91%

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

Waseem

Nayar

Hull

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…In the United Kingdom (UK), this has led to unprecedented pressures on the NHS [ 8 ]. Even during this pandemic, patients with hip fractures remain one of the commonest reasons for admissions [ 9 – 11 ]. Over 60,000 hip fractures occur annually and represent a significant proportion of the trauma workload for most hospitals [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Expedited surgery, usually in the form of fixation, a hemiarthroplasty or total hip replacement, is usually indicated for most patients, as this is associated with better outcomes for patients [ 15 , 16 ]. Although almost all planned surgery has been cancelled in the UK during this pandemic [ 17 ], the incidence of hip fractures requiring emergency surgical intervention during this period has remained constant [ 9 – 11 ]. The British Orthopaedic Association (BOA) issued guidance on how to manage trauma patients in the COVID-19 situation.…”

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

Wignall

Giannoudis

et al. 2021

J Orthop Surg Res

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Background On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the impact of COVID-19 on the demographics, presentation, clinical management and outcomes of patients with proximal femoral (hip) fractures comparing them to a similar cohort of patients admitted a year earlier. Methods This retrospective multi-centre cohort study compared all patients admitted with hip fractures between 1st March and 30th May 2019 (group PC: pre-COVID-19) with hip fracture patients admitted over the same time period during the pandemic in 2020 (group C: COVID-19). The data was obtained from the hospitals’ local and National Hip Fracture Databases. Mortality data was checked with the Office for National Statistics (ONS). Primary outcomes were time to theatre, in-patient length of stay and 30-day mortality. Results A total of 580 patients were included (304 group PC, 276 group C). Patient demographics including Charlson Comorbidity Index and Nottingham Hip Fracture Scores were broadly similar across the two cohorts. There was a significant reduction in the percentage of total hip replacements (11 to 5%, p = 0.006) in group C. There was an increase in conservative management (1 to 5%, p = 0.002) in group C. Time to theatre was significantly delayed in group C (43.7 h) vs group PC (34.6 h) (p ≤ 0.001). The overall length of hospital stay was significantly longer in group PC (16.6 days) vs group C (15 days) (p = 0.025). The 30-day mortality rate in group C was 9.8% compared to 8.2% in group PC (p = 0.746), but for COVID-19 (+) patients, it was significantly higher at 38.2% vs 5.8% in COVID-19 (−) patients (p < 0.001). Conclusion This is one of the largest multi-centre comparative cohort study in the literature to date examining the impact of the COVID-19 pandemic on the management of hip fracture patients. Whilst mortality rates were similar in both groups, COVID-19-positive patients were almost seven times more likely to die, reflecting the seriousness of the COVID-19 infection and its sequelae in such elderly, vulnerable patients.

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“…32 Luceri et al stated decrease in patient flow in Milan, Italy due to COVID-19. 33 They partially attributed the decrease to people's fear of contagion from emergency department. They also identified social isolation as a cause of reduction of trauma in general population.…”

Section: Discussionmentioning

confidence: 99%

“…They also identified social isolation as a cause of reduction of trauma in general population. 33 Leibensteiner et al reported drastic reduction in arthroscopic procedure among German speaking orthopaedic surgeon in Austria, Germany and Switzerland, while 20% reported of shutting down of all orthopaedic procedures. 34 They believed that orthopaedic surgery will not be able to return to pre-pandemic level earlier than within 3 months.…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review

Kayastha

Parajuli

Basi

et al. 2020

Kathmandu Univ. Med. J.

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Background The Nepal government issued a nationwide lockdown due to COVID-19 from 24 March to 21 July 2020. This halted elective medical services in our hospital. A number of modifications in the orthopaedic practices at our department were made. Objective This article discusses the impact on orthopaedic load at the Department of Orthopaedics and Trauma, Dhulikhel Hospital, Kathmandu University Hospital during the lockdown. Method This is a longitudinal observational study done during the nation-wide lockdown including all the patients who presented to the hospital requiring orthopaedic consultation. For comparison purposes, the patient numbers from the same date in previous year (2019) were retrieved. Result We received no COVID-19 cases requiring orthopaedics consultation. A total of 1828 patients were seen in the Orthopaedic Outpatient Department, 1077 trauma patients in the Emergency Department, 216 patients were admitted and 210 orthopaedics procedures were performed at the operation theatre. There was 82.21% decrease in OPD patients and 56% less surgeries in OT compared to the same duration of last year. Conclusion There was a great reduction in the patient numbers visiting the hospital, which reflected in decreased number of admission and surgery. A greater part of our work during the lockdown was trauma.

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Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department

Cited by 58 publications

References 17 publications

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

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

The impact of COVID-19 on the management and outcomes of patients with proximal femoral fractures: a multi-centre study of 580 patients

Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review

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