scholarly journals The impact of COVID-19 on acute Trauma and Orthopaedic referrals and surgery in the UK: the "golden peak weeks" of the first national multi-centre observational study. The COVid-Emergency Related Trauma and orthopaedics (COVERT) Collaborative

2020 ◽  
Author(s):  
Kapil Sugand ◽  
Keyword(s):  
Operative Intervention ◽  
National Study ◽  
Orthopaedic Trauma ◽  
Odds Ratios ◽  
Neck Of Femur ◽  
Acute Trauma ◽  
Clinical Encounters ◽  
Femur Fractures ◽  
The Uk ◽  
The Impact

Objectives: This is the first national study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during the first six weeks (namely the "golden peak weeks") following the introduction of the national social distancing and lockdown measures from mid-March 2020. Design: A longitudinal, national, multi-centre, retrospective, observational, cohort study was conducted for the first six weeks from March 17, 2020 from start of the national social distancing and then lockdown compared to the same period in 2019 as a comparative baseline. Setting: Hospitals from seven major urban cities were recruited around the UK, including London, representing a comprehensive national picture of the impact of COVID-19 pandemic and its lockdown at its peak. Participants: A total of 4840 clinical encounters were initially recorded. Exclusion criterion consisted of spinal pathology only. Post-exclusion, 4668 clinical encounters were recorded and analysed within the two timeframes. Main outcome measures: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, patient demographics, mortality rates, and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia utilised. Demographics for each patient was recorded along with underlying medical co-morbidities. Sub-group analysis compared mortalities between both cohorts. Statistical analyses included mean (+/-SD), risk and odds ratios, as well as Fisher's exact test to calculate the statistical significance (p = 0.05). Results: During the COVID-19 period there was a 34% reduction in acute orthopaedic trauma referrals compared to 2019 (1792 down to 1183 referrals), and 29.5% less surgical interventions (993 down to 700 operations). The mortality rate significantly (both statistically and clinically) more than doubled for both risk and odds ratios during the COVID period in all referrals (1.3% vs 3.8%, p=0.0005) and in those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-related complications (versus non-COVID causes) had greater odds by a factor of at least 20 times. The odds ratios of road traffic accidents, sporting injuries, infection, and lower limb injuries were significantly less (by a third to a half) during the COVID period; albeit, the odds of sustaining neck of femur fractures and having falls <1.5m increased by more than 50%. For the operative cohorts, there was a greater odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters as well as doubling of the odds of a Consultant acting as the primary surgeon. Nevertheless, the odds of open reduction and internal fixation reduced by a quarter whereas removal of metalwork or foreign bodies reduced by three-quarters. Six-week Kaplan-Meier survival probability analysis confirmed those patients with neck of femur fracture and pre-existing cardiovascular and cerebrovascular disease were most at risk of mortality during the COVID-19 era. Conclusion: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared to the same time interval one year ago. Elderly patients with neck of femur fractures and existing cardiovascular and cerebrovascular comorbidities were at the highest risk stratification for mortality. This was the first national study to assess impact of COVID-19 pandemic on acute Orthopaedic trauma and it will aid clinicians in counselling trauma patients of the increased risk of mortality during the era of COVID-19 as well as acting as a risk-prediction tool influencing policymaking as the pandemic continues with potential subsequent waves. Further studies after the lifting of the lockdown are also required to observe for return of standard practice.

scholarly journals Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

2021 ◽  
Author(s):  
Chang Park ◽  
Kapil Sugand ◽  
Arash Aframian ◽  
Catrin Morgan ◽  
Nadia Pakroo ◽  
...  
Keyword(s):  
Best Practice ◽  
Neck Of Femur ◽  
Health Crisis ◽  
Femur Fractures ◽  
Time Period ◽  
Vulnerable Patients ◽  
Significant Difference ◽  
Usual Residence ◽  
Hip Trauma ◽  
The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

Does the Nottingham Hip Fracture Score Help Predict Which Patients Will Benefit From a Modern Modular Hemiarthroplasty for the Treatment of Intracapsular Proximal Femoral Fractures?

2021 ◽  
Author(s):  
Sush Ramakrishna Gowda
Keyword(s):  
Hip Fracture ◽  
Femoral Fractures ◽  
High Volume ◽  
Neck Of Femur ◽  
Residential Status ◽  
Orthopaedic Department ◽  
Femur Fractures ◽  
Modular Prostheses ◽  
The Uk ◽  
To Receive

Introduction: Hemiarthroplasty for the management of intracapsular neck of femur fractures is common but current practice in the UK still varies regionally and individually. Guided by the National Institute of Health and Care Excellence (NICE) we have observed a move towards modern, modular prostheses such as the Exeter V40 Stem but the use of older, monoblock prostheses such as the Thompsons Hemiarthroplasty remains controversial. Use of the Nottingham Hip Fracture Scores (NHFS) can help surgeons stratify patients according to risk and select the most appropriate prosthesis to meet their individual needs. Materials and Methods: 765 hip hemiarthroplasties were analysed over a 28-month period at a single, high-volume, orthopaedic department in the UK. We calculated the NHFS and recorded the choice of prosthesis. Patients were then followed up for at least a year. Outcomes were mortality and change in residential status. Results: Six hundred and forty-six (446) patients were treated with monoblock prostheses (mean age=85.6; range 62-105). 319 patients received modular prostheses (mean age=81.0; range 61-98). Patients who were selected to receive a monoblock prosthesis were over twice as likely to be dead at a year (32.87% vs. 13.65%) and over twice as likely to require increased assistance with living (50.12% vs. 23.81%). Amongst patients with equivocal NHFS, those who receive a monoblock stem suffered worse outcomes in all but the very highest risk group, who experienced lower mortality (OR=0.71, CI 0.52-0.96) and change in residential status (OR=0.76, CI 0.58-0.99). Conclusion: Nottingham Hip Fracture Score (NHFS) can confer predictable outcomes in hip fracture patients treated with modular stems. Modular stems should be the default choice when performing hemiarthroplasties for intracapsular neck of femur fractures. However, in keeping with other studies, we found that in very old, frail, or co-morbid patients, modular stems are not associated with better survival or return to pre-morbid function.

scholarly journals Loneliness and Its Associated Factors Nine Months after the COVID-19 Outbreak: A Cross-National Study

2021 ◽  
Vol 18 (6) ◽  
pp. 2841
Author(s):  
Tore Bonsaksen ◽  
Mariyana Schoultz ◽  
Hilde Thygesen ◽  
Mary Ruffolo ◽  
Daicia Price ◽  
...  
Keyword(s):  
Social Media ◽  
Cross Sectional Study ◽  
National Study ◽  
Cross Sectional ◽  
Daily Lives ◽  
Emotional Loneliness ◽  
The Usa ◽  
The Uk ◽  
Cross National Study ◽  
The Impact

COVID-19 has been a global healthcare concern impacting multiple aspects of individual and community wellness. As one moves forward with different methods to reduce the infection and mortality rates, it is critical to continue to study the impact that national and local “social distancing” policies have on the daily lives of individuals. The aim of this study was to examine loneliness in relation to risk assessment, measures taken against risks, concerns, and social media use, while adjusting for sociodemographic variables. The cross-sectional study collected data from 3474 individuals from the USA, the UK, Norway, and Australia. Loneliness was measured with the de Jong Gierveld Loneliness Scale. Multiple linear regression was used in the analysis of associations between variables. The results showed that concerns about finances were more strongly associated with social loneliness, while concerns about the future was more strongly associated with emotional loneliness. Longer daily time spent on social media was associated with higher emotional loneliness. In conclusion, pandemic-related concerns seem to affect perceptions of loneliness. While social media can be used productively to maintain relationships, and thereby prevent loneliness, excessive use may be counterproductive.

scholarly journals The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases

2020 ◽  
Vol 1 (5) ◽  
pp. 137-143 ◽  
Author(s):  
Matthew Hampton ◽  
Matthew Clark ◽  
Ian Baxter ◽  
Richard Stevens ◽  
Elinor Flatt ◽  
...  
Keyword(s):  
Major Trauma ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Hand Injuries ◽  
Orthopaedic Trauma ◽  
Nerve Injuries ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
The Uk ◽  
The Impact

Aims The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. Methods Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. Results There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). Conclusion The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.

scholarly journals O22 Evaluating the impact of COVID-19 on patient access to rheumatology services, medication and future care: a nationwide study of more than 2,000 patients

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Chris Wincup ◽  
Raj Amarnani ◽  
Ian Giles
Keyword(s):  
Drug Monitoring ◽  
Online Survey ◽  
British Society ◽  
National Study ◽  
Telephone Consultation ◽  
Patient Reported ◽  
Future Care ◽  
The Uk ◽  
The Impact

Abstract Background/Aims  COVID-19 has had significant impacts upon the delivery of rheumatology care in the UK. To date, there is little data specifically addressing how care has been disrupted and the impact upon patient attitudes and beliefs. Herein, we describe the results of a national study investigating how COVID-19 has; (1) reduced access to services; (2) altered treatment and drug monitoring; (3) impacted on clinic follow-up; (4) changed patient beliefs regarding ongoing/future care. Methods  We conducted an online survey of patients attending rheumatology clinics in the UK. Questions were developed by clinicians with input from patient charities and four expert patients. The survey was hosted online between 8 September and 8 October 2020. Results  In total, 2,054 patients completed the survey and the average number of rheumatic conditions each patient reported was 1.98±1.38 with the most common being; rheumatoid arthritis (48%), lupus (20%), Sjogren’s syndrome (19%), fibromyalgia (15%) and vasculitis (8%). More than half (57%) were told to shield, whilst 10% decided to shield of their own accord. Compared with before the pandemic, 57% felt it was difficult/very difficult to contact their rheumatologist. Regarding treatment, 15% reported difficulty obtaining their usual medication. Less than half (45%) of patients continued medication as previously and had no problem accessing it, although 21% said their usual drug monitoring had been discontinued. Overall, 3% stopped their treatment of their own accord. In all, 26% said their appointments in rheumatology clinics had been cancelled and they did not know when they would be seen again (4% reported no change in their outpatient follow-up). Prior to the pandemic, 13% of patients had received a telephone consultation, however, since the pandemic 60% had received one. Just 19% felt it was easy to be honest with their clinician via telephone. Only 33% were satisfied with the current level of care, 43% reported their rheumatology care was worse than pre-pandemic and 38% of patients felt they needed to see their rheumatologist but could not get an appointment. Over half (57%) of patients expressed worries about their future care. If offered an appointment in the next few months 66% said they would prefer it be face-to-face. Conclusion  To our knowledge, this study is the largest survey of patient experiences of the COVID-19 pandemic under rheumatological care anywhere in the world. We found more than half of patients were told to shield and one-in-ten decided to shield without being directly told to do so. Less than half of patients maintained relatively good access to their usual medication without necessary monitoring in many cases. In particular, patients express high levels of concern about their future care. These high levels of disruption indicate the importance of maintaining routine rheumatology services during the ongoing pandemic. Disclosure  C. Wincup: Grants/research support; CW has received research funding from Versus Arthritis, LUPUS UK and the British Society for Rheumatology. R. Amarnani: None. I. Giles: None.

scholarly journals Using the United Kingdom standards for public involvement to evaluate the impact of public involvement in a multinational clinical study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kathy Seddon ◽  
Jim Elliott ◽  
Miriam Johnson ◽  
Clare White ◽  
Max Watson ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Study ◽  
Clinical Research ◽  
Public Involvement ◽  
Lead Author ◽  
National Study ◽  
The United Kingdom ◽  
Lay Members ◽  
The Uk ◽  
The Impact

Abstract Background The publication of the United Kingdom (UK) Standards for Public Involvement (PI) (UK Standards) in research drew a clear line in the sand regarding the importance of utilising the unique experience, skills and expertise that lay people may offer to the development, conduct and dissemination of clinical research. The UK Standards provide a benchmark which researchers should aim to achieve, yet its implementation continues to be a step wise iterative process of change management. A recent evaluation by a regional research group has suggested that our understanding of PI is enhanced through reflection on the UK Standards. We report on the utility of PI in the design, conduct and dissemination of the HIDDen study, a national, multicentre clinical study based across three UK centres. Methods A retrospective review of PI within the HIDDen study was conducted using field notes taken by the lead author from interactions throughout their involvement as a lay representative on the study. Key members of the HIDDen study were interviewed and data analysed to explore adherence to the UK Standards. Results There was universal support for PI across the study management group with genuine inclusivity of lay members of the committee. All six of the UK Standards were met to varying degrees. The greatest opportunities lay in ‘working together’ and ‘support and learning’. There were challenges meeting ‘governance’ with evidence of participation in decision making but less evidence of opportunities in management, regulation, leadership. Conclusion This study concurs with previous research supporting the utility of the Standards in the conduct and evaluation of PI in clinical research. To our knowledge this is the first multi-national study to be evaluated against the UK Standards.

scholarly journals The TROJAN project: creating a customized international orthopedic training program for junior doctors

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Ashish Kalraiya ◽  
Pranai Buddhdev
Keyword(s):  
South Africa ◽  
Training Program ◽  
Daily Practice ◽  
Junior Doctors ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Reduction Techniques ◽  
Management Plans ◽  
Musculoskeletal Problems ◽  
The Uk

Musculoskeletal problems account for a vast proportion of presentations encountered by doctors globally, with figures ranging from 15-36%. However, the time medical schools allocate to learning orthopedics is by no means proportional to this. This study aims to bridge this gap by developing an international orthopedic teaching program tailored to the specific knowledge and skills required by junior doctors in different countries. This prospective study asked fifty junior doctors, who had recently completed an orthopedics job, what three orthopedic teaching topics taught retrospectively would have benefitted their clinical practice. The most requested topics were used to design educational workshops for junior doctors and these consequently comprised the TROJAN (Teaching Requested by Orthopaedic Juniors And Novices) training program. Data was collected from twenty-five junior doctors in KwaZulu-Natale State, South Africa, and twenty-five in London, UK. It is therefore in these two countries that the TROJAN program was subsequently made available. Participants who selected topics were within two years of graduating medical school and had worked an orthopedic or Accident and Emergency job within the last year. 49% of topics chosen by SA doctors were practical skills such as wrist and ankle fracture reduction techniques, and management of open fractures. The most requested topic by UK doctors (11 out of 25) was management of neck of femur fractures. This is rationalized by the fact South African doctors require more handson responsibility in their daily practice whereas in the UK greater emphasis is placed on optimizing patients for theatre and making sound management plans. TROJAN currently develops orthopedic skills and knowledge in junior doctors in South Africa and United Kingdom with teaching customized based upon location. Feedback has been exceptionally positive with every candidate thus far rating the usefulness of TROJAN as the highest option, <em>very useful.</em>

The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

2020 ◽  
pp. 112070002097202
Author(s):  
Hiba Khan ◽  
Al-Achraf Khoriati ◽  
Stefan Lazic ◽  
Jack Navein ◽  
Ritesh Sharma ◽  
...  
Keyword(s):  
High Risk ◽  
Femur Fracture ◽  
Mortality Rates ◽  
Time Frame ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Femur Fractures ◽  
American Society ◽  
Neck Of Femur Fracture ◽  
The Impact

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

scholarly journals 1414 The Impact Of COVID-19 On Individuals with Neck of Femur Fracture in The United Kingdom: A Systematic Review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Andritsos ◽  
O Thomas ◽  
S Pallikadavath ◽  
S Sambhwani ◽  
S Kirmani
Keyword(s):  
Systematic Review ◽  
Femur Fracture ◽  
Meta Analysis ◽  
Case Series ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Level 3 ◽  
The Uk ◽  
Neck Of Femur Fracture ◽  
The Impact

Abstract Aim All Neck of Femur fracture patients have a significant 30 – day mortality despite efforts to improve their outcomes. Incidence of NOF cases remained high during the pandemic in the UK and as a result numerus cases were complicated with SARS-CoV-2 infection. We performed a systematic review and meta-analysis of all UK published studies related to NOF fractures and 30-day mortality outcomes during the COVID 19 pandemic. Method A systematic review and meta-analysis was performed and reported as per the PRISMA checklist. Two reviewers independently searched on Medline for UK studies that were published between 1stof March 2020 and 1stof November 2020. Outcomes compared were 30-day mortality, time to surgery and anaesthetic risk. Results A total of 5 articles were included in our study. These studies were all case series with evidence level 3 or 4. A total of 286 patients complicated with COVID infection with a range of 30-day mortality 30.5%-50%. OR 6.02(95CI: 4.10-8.85), Chi24.82, I2 58%. Increased time to surgery due to Coronavirus related delays was also noted for the majority of studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip fracture score) failed to accurately predict the mortality risk. Conclusions Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.

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