Pediatric Orthopedic Trauma Care During the COVID-19 Pandemic: A Survey of the Pediatric Orthopedic Society of North America

Background: The COVID-19 pandemic has dramatically altered the practice of pediatric orthopedic trauma surgery in both outpatient and inpatient settings. While significant declines in patient volume have been noted, the impact on surgeon decision-making is unclear. Purpose: We sought to investigate changes in pediatric orthopedic trauma care delivery as a result of COVID-19 and determine their implications for future orthopedic practice. Methods: An electronic survey was distributed to all members (N = 1515) of the Pediatric Orthopedic Society of North America (POSNA) in March to April 2021; only members who provided care for pediatric orthopedic trauma patients were asked to complete it. The survey included questions on hospital trauma call, inpatient care, outpatient clinic practice, and 3 unique fracture case scenarios. Results: A total of 147 pediatric orthopedic surgeons completed the survey, for a 9.7% response rate, with 134 (91%) taking trauma call at a hospital as part of their practice. Respondents reported significant differences across institutions regarding COVID-19 testing, hospital rounding, and employee COVID-19 screening. Changes in outpatient fracture management were observed, including a decreased number of follow-up visits for nondisplaced clavicle fractures, distal radius buckle fractures, and toddler’s fractures. Of respondents who changed their fracture follow-up schedules due to COVID-19, over 75% indicated that they would continue these outpatient treatment schedules after the pandemic. Conclusions: This survey found changes in pediatric orthopedic trauma care as a result of the COVID-19 pandemic. The use of telemedicine and abbreviated follow-up practices for common fracture types are likely to persist following the resolution of the COVID-19 pandemic.

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Change in Orthopedic Trauma Practice under Strict Lockdown due to COVID-19 Pandemic

The Open Public Health Journal ◽

10.2174/1874944502114010196 ◽

2021 ◽

Vol 14 (1) ◽

pp. 196-205

Author(s):

Anas A.R. Altamimi ◽

Ali A. Al-Omari ◽

Saeed Al-Naser ◽

Firas Al-Dabouby ◽

Mahmoud Al-Balas ◽

...

Keyword(s):

Response Rate ◽

Legal Aspects ◽

Trauma Patients ◽

Orthopedic Trauma ◽

University Hospitals ◽

Cross Sectional ◽

Femur Fractures ◽

Orthopedic Surgeons ◽

The Impact

Introduction: The COVID-19 pandemic has led to remarkable changes in several aspects of medical practice. Elective surgeries, including orthopedic surgery, were deferred worldwide, allowing hospitals to accommodate higher numbers of COVID-19 patients and reduce the possible risk of infection among healthcare workers. However, healthcare systems aimed to continue providing emergency services at similar standards. In this study, we aim to highlight the impact of lockdowns secondary to the pandemic on orthopedic trauma practice in a country that was described to have one of the strictest lockdowns worldwide. We aim to examine the trends of change in number and type of orthopedic trauma cases and the changes to decision making and patient care among orthopedic surgeons. Methods: This cross-sectional study is based on a survey that was designed and delivered to orthopedic surgeons from different health sectors i.e. governmental, military, private and university hospitals. The questionnaire was distributed through the official Jordan orthopedic association WhatsApp group by the end of the 4th week of strict lockdown. A total of 256 orthopedic surgeons were invited to participate and responses were limited to one per participant. 147 replies were received with a response rate of 57.4%. Data were analyzed using the Statistical Package for the Social Sciences Version 23 (SPSS Inc., Chicago, IL) statistical software. Results: A total of 147 surgeons participated in the study with a response rate of 57.4%. The mean age of the participants was 39.8 years, with the majority being between 30 and 40 years (n=70; 48%). There was a significant decline in the number of trauma cases admitted to the Emergency Departments (ER), especially cases with polytrauma. During this period, the most common reported fractures were proximal femur fractures (47.6%) followed by distal radius fracture (17%). 30% of participants used to perform more than 10 trauma operations per week. This percentage dropped to 7.5% during the pandemic lockdown. 25% did not operate at all during the lockdown period. Outpatients practice was significantly affected with almost 40% of orthopedic surgeons not managing any single patient. Regarding the use of Personal Protective Equipment (PPE), 85% of the surgeons used face masks and gloves only during their patient's encounter. Inside the operating room, only 9.5% of surgeons used fully protective PPEs. Regarding the changes in practice, 62% of surgeons reported an increased tendency toward non-operative management with a significant delay in follow up of patients. The use of telemedicine was effective in the management of less than 50% of patient encounters, according to our participants. Private practice respondents reported more than 50% drop in their income during the lockdown. Conclusion: Strict lockdown in Jordan led to significant changes to orthopedic trauma practice in terms of the number and type of cases. Emergency and outpatient services were similarly affected. Orthopedic surgeons developed a tendency towards more conservative management and less surgical treatment. There is a need for stricter implementation of guidelines regarding the use of PPE especially in the operating theatre. Telemedicine use in management and follow up of trauma patients needs further assessment in terms of its efficacy and efficiency to patients and to healthcare professionalswith regards to its medico-legal aspects.

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Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

Children ◽

10.3390/children8070530 ◽

2021 ◽

Vol 8 (7) ◽

pp. 530

Author(s):

Giovanni Trisolino ◽

Renato Maria Toniolo ◽

Lorenza Marengo ◽

Daniela Dibello ◽

Pasquale Guida ◽

...

Keyword(s):

Trauma Surgery ◽

Nationwide Survey ◽

Emergency Department Visits ◽

Pediatric Orthopedics ◽

Significant Drop ◽

Surgical Interventions ◽

Pediatric Orthopedic ◽

Orthopedic Patients ◽

The Impact ◽

Second Wave

Background: We aimed to investigate the variation of medical and surgical activities in pediatric orthopedics in Italy, during the year of the COVID-19 pandemic, in comparison with data from the previous two years. The differences among the first wave, phase 2 and second wave were also analyzed. Methods: We conducted a retrospective multicenter study regarding the clinical and surgical activities in pediatric orthopedics during the pandemic and pre-pandemic period. The hospital databases of seven tertiary referral centers for pediatric orthopedics and traumatology were queried for events regarding pediatric orthopedic patients from 1 March 2018 to 28 February 2021. Surgical procedures were classified according to the “SITOP Priority Panel”. An additional classification in “high-priority” and “low-priority” surgery was also applied. Results: Overall, in 2020, we observed a significant drop in surgical volumes compared to the previous two years. The decrease was different across the different classes of priority, with “high-priority” surgery being less influenced. The decrease in emergency department visits was almost three-fold greater than the decrease in trauma surgery. During the second wave, a lower decline in surgical interventions and a noticeable resumption of “low-priority” surgery and outpatient visits were observed. Conclusion: Our study represents the first nationwide survey quantifying the impact of the COVID-19 pandemic on pediatric orthopedics and traumatology during the first and second wave.

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Managing the multiply injured patient: the impact of multidisciplinary teams

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.12.703 ◽

2019 ◽

Vol 80 (12) ◽

pp. 703-706

Author(s):

Jonathan French ◽

Lewis M Agius ◽

Nemandra A Sandiford

Keyword(s):

Trauma Care ◽

Care Delivery ◽

National Level ◽

Injured Patient ◽

Improve Patient Care ◽

Multidisciplinary Teams ◽

Team Approach ◽

Trauma Service ◽

Multiply Injured Patient ◽

The Impact

Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.

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Retained Foreign Bodies after Emergent Trauma Surgery: Incidence after 2526 Cavitary Explorations

The American Surgeon ◽

10.1177/000313480707301024 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1031-1034 ◽

Cited By ~ 9

Author(s):

Pedro G.R. Teixeira ◽

Kenji Inaba ◽

Ali Salim ◽

Carlos Brown ◽

Peter Rhee ◽

...

Keyword(s):

Foreign Bodies ◽

Damage Control ◽

Trauma Surgery ◽

Radiographic Evaluation ◽

Trauma Patients ◽

X Rays ◽

Chest X Ray ◽

Cavity Closure ◽

Level 1 Trauma Center

Trauma patients are thought to be at high risk for iatrogenic retained foreign bodies (RFBs). The objective of this study was to evaluate this incidence. All cases of RFB after cavitary trauma surgery were identified by review of Morbidity and Mortality reports at a Level 1 trauma center from January 1998 to December 2005 and confirmed by the Octagon Risk Management System. Over 8 years, 10,053 trauma operations were performed (2075 laparotomies, 377 thoracotomies, and 74 sternotomies). Three cases (0.1%) of RFB (all sponges) occurred during one single-stage and two damage control laparotomies. The counts were correct before definitive closure in two of three cases. No postoperative x-rays were obtained in any of the cases. RFB diagnosis occurred between days 3 and 9, one on a routine chest x-ray and the other two on abdominal computed tomography scans during a septic workup. Four-month to 8-year follow up documented one pleural effusion and one abscess resulting from the RFB. Iatrogenic RFBs after emergent cavitary trauma surgery occur at a rate of 0.12 per cent and are associated with significant morbidity. In addition to standard preventive strategies, in emergent cases with risk factors such as requiring damage control, before final cavity closure, even with a correct sponge count, radiographic evaluation is warranted.

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Pioneering orthopaedic trauma surgery in Turkey: Burhaneddin Toker (1890–1951), the stormy 1930s, and refugees running from Nazism

Journal of Medical Biography ◽

10.1177/0967772020935016 ◽

2020 ◽

pp. 096777202093501

Author(s):

Erdem Bagatur

Keyword(s):

Orthopedic Surgery ◽

Medical Training ◽

Trauma Surgery ◽

Musculoskeletal Injuries ◽

Trauma Patients ◽

Orthopedic Trauma ◽

The West ◽

Scientific Publications ◽

Medical Discipline ◽

Republican Government

Orthopedic surgery, the medical discipline that deals with diseases and injuries of the musculoskeletal system has been considered a distinct medical discipline in the west since the beginning of the twentieth century. However, in Turkey, the acceptance of musculoskeletal traumatology as an integral part of orthopedic surgery actualized as late as 1961. Previously, orthopedic trauma patients were usually treated in general surgery departments. Dr. Burhaneddin Toker, a true pioneer, changed this conduct of the time in Turkey. He transformed Cerrahpaşa Hospital, then a municipality hospital today the well-known Cerrahpaşa Medical School of Istanbul University, to a trauma center. He pioneered systematic surgery of the musculoskeletal injuries, created a separate service for musculoskeletal traumatology, trained many surgeons in this field, wrote textbooks, and reported his clinical experience in scientific publications. This study examines the biography of Burhaneddin Toker and how he was able to further medical training in Turkey with a focus on Turkey in the stormy 1930s, the way the young republican government under Atatürk’s leadership handled educational issues, and the refugee scientists who found a safe haven in Turkey fleeing Nazism.

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Sources of variation in follow-up expenditure after radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.335 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 335-335

Author(s):

Goutham Vemana ◽

Joel Vetter ◽

Ling Chen ◽

Gurdarshan Singh Sandhu ◽

Seth A. Strope

Keyword(s):

Radical Cystectomy ◽

Practice Patterns ◽

Care Delivery ◽

Total Variance ◽

Office Visits ◽

Recommended Care ◽

Patient Level ◽

Follow Up Care ◽

The Impact

335 Background: Follow-up care after radical cystectomy is poorly defined with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic impact of standardization of care to guideline recommended care. Methods: Using linked SEER-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted costs included office visits, imaging studies, urine tests and blood work. A multilevel model was implemented to determine the impact of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) to the expenditures if patients received care recommended by current clinical guidelines. Results: Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median monthly expenditures were $33 and $21 respectively (minimum $0, maximum $429, 25th to 75th percentile $9 to $43). The total variance of expenditure situated at the surgeon-level and SEER region-level was 9.9% and 4.0% respectively. After accounting for the region, the total variance of expenditure situated at the patient-level and surgeon-level was 14.95% and 7.81% respectively. The assessed cost of guideline follow-up recommendations varied from 0.78-9.05 times the calculated Medicare costs. The guideline recommended cost of follow-up was higher than actual Medicare expenditures in all but one category. Conclusions: While some regional and surgeon-level variations in care were found, most variation in expenditure on follow-up care was at the patient-level, largely based on comorbidity, node positivity, chemotherapy status, readmission rates, and final cancer stage. Standardization of care to current established guidelines would create larger expenditures for the Medicare system than current practice patterns.

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What factors influence follow-up in orthopedic trauma surgery?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-015-2151-8 ◽

2015 ◽

Vol 135 (3) ◽

pp. 321-327 ◽

Cited By ~ 32

Author(s):

Paul S. Whiting ◽

Sarah E. Greenberg ◽

Rachel V. Thakore ◽

Vignesh K. Alamanda ◽

Jesse M. Ehrenfeld ◽

...

Keyword(s):

Trauma Surgery ◽

Orthopedic Trauma ◽

Orthopedic Trauma Surgery

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Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00938-7 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jeanette Finstad ◽

Olav Røise ◽

Leiv Arne Rosseland ◽

Thomas Clausen ◽

Ingrid Amalia Havnes

Keyword(s):

Mental Health ◽

Pain Management ◽

Trauma Care ◽

Information Needs ◽

Trauma Centre ◽

Trauma Survivors ◽

Trauma Patients ◽

Post Discharge ◽

Physical Trauma

Abstract Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Discharge From the Trauma Hospital as A Transition Into Insecurity, - Experiences Among Physical Trauma Survivors

10.21203/rs.3.rs-105447/v1 ◽

2020 ◽

Author(s):

Jeanette Finstad ◽

Olav Røise ◽

Leiv Arne Rosseland ◽

Thomas Clausen ◽

Ingrid Amalia Havnes

Keyword(s):

Mental Health ◽

Pain Management ◽

Trauma Care ◽

Trauma Survivors ◽

Surgical Trauma ◽

Trauma Patients ◽

Treatment Needs ◽

Post Discharge ◽

Physical Trauma

Abstract Background: Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma center in Norway that provides the highest level of surgical trauma care. Method: Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results: The overarching theme was that discharge from the trauma hospital and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was a) unmet information needs about the injury, b) exposure to opioids, and c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion: The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study (Preprint)

10.2196/preprints.20874 ◽

2020 ◽

Cited By ~ 1

Author(s):

Maria Guarino ◽

Valentina Cossiga ◽

Andrea Fiorentino ◽

Giuseppina Pontillo ◽

Filomena Morisco

Keyword(s):

Health Care ◽

Liver Disease ◽

Observational Study ◽

Chronic Liver Disease ◽

Prospective Observational Study ◽

Care Delivery ◽

Care Center ◽

Social Distancing ◽

The Impact

BACKGROUND The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. METHODS From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

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