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

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.

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257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre

British Journal of Surgery ◽

10.1093/bjs/znab259.979 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M S Jamal ◽

D Hay ◽

K Al-Tawil ◽

A Petohazi ◽

V Gulli ◽

...

Keyword(s):

Mental Health ◽

Psychiatric Diagnosis ◽

Major Trauma ◽

Mental Health Problems ◽

Demographic Data ◽

Trauma Centre ◽

Related Factors ◽

Number Of Patients ◽

Major Trauma Centre ◽

The Impact

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

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Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

10.21203/rs.3.rs-118238/v2 ◽

2020 ◽

Author(s):

Debkumar Chowdhury ◽

P. Okoh ◽

H. Dambappa

Keyword(s):

Major Trauma ◽

Significant Proportion ◽

Fragility Fractures ◽

Trauma Centre ◽

Rib Fractures ◽

Rib Fracture ◽

Analgesic Requirement ◽

Multiple Rib Fractures ◽

Major Trauma Centre ◽

The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

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Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

10.21203/rs.3.rs-118238/v1 ◽

2020 ◽

Author(s):

Debkumar Chowdhury ◽

P. Okoh ◽

H. Dambappa

Keyword(s):

Major Trauma ◽

Significant Proportion ◽

Fragility Fractures ◽

Trauma Centre ◽

Rib Fractures ◽

Rib Fracture ◽

Analgesic Requirement ◽

Multiple Rib Fractures ◽

Major Trauma Centre ◽

The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

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The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7026 ◽

2021 ◽

Vol 103 (2) ◽

pp. 114-119

Author(s):

D Hay ◽

MS Jamal ◽

K Al-Tawil ◽

A Petohazi ◽

V Gulli ◽

...

Keyword(s):

Mental Health ◽

Psychiatric Diagnosis ◽

Major Trauma ◽

Mental Health Problems ◽

Demographic Data ◽

Trauma Centre ◽

Related Factors ◽

Number Of Patients ◽

Major Trauma Centre ◽

The Impact

Introduction Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. Materials and methods We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. Results There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. Discussion There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. Conclusion While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential ‘second wave’ of COVID-19.

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The impact of Major Trauma Centre (MTC) status on paediatric orthopaedic service delivery – 1 year after MTC status designation.

International Journal of Surgery ◽

10.1016/j.ijsu.2013.05.023 ◽

2013 ◽

Vol 11 (7) ◽

pp. 566

Author(s):

Assad Farooq ◽

Ravindran Visagan ◽

Yaser Jabber ◽

Raj Bhattacharya ◽

Sally Tennant ◽

...

Keyword(s):

Service Delivery ◽

Major Trauma ◽

Trauma Centre ◽

Major Trauma Centre ◽

Paediatric Orthopaedic ◽

The Impact

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The impact of alcohol intoxication in patients admitted due to assault at an Australian major trauma centre: a trauma registry study from 1999 to 2009

Emergency Medicine Journal ◽

10.1136/emermed-2012-202076 ◽

2013 ◽

Vol 31 (5) ◽

pp. 390-393 ◽

Cited By ~ 10

Author(s):

Michael M Dinh ◽

Kendall J Bein ◽

Susan Roncal ◽

Alexandra L C Martiniuk ◽

Soufiane Boufous

Keyword(s):

Major Trauma ◽

Trauma Registry ◽

Alcohol Intoxication ◽

Trauma Centre ◽

Registry Study ◽

Major Trauma Centre ◽

The Impact

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598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown

British Journal of Surgery ◽

10.1093/bjs/znab259.471 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Payne ◽

E Campbell ◽

T Welman ◽

G Pahal ◽

S Myers

Keyword(s):

Plastic Surgery ◽

Major Trauma ◽

Healthcare Delivery ◽

Total Body Surface Area ◽

Trauma Centre ◽

Control Group ◽

Major Trauma Centre ◽

The Government ◽

The Uk ◽

Surgery Department

Abstract Aim The COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period. Method Retrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed. Results Fifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes. Conclusions Despite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.

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1651 Improving Surgical Admission Clerking in A Major Trauma Centre – The Role of a Standardised Clerking Proforma

British Journal of Surgery ◽

10.1093/bjs/znab259.784 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Arnaouti ◽

M Foxall-Smith ◽

D Mittapalli

Keyword(s):

Major Trauma ◽

Service Evaluation ◽

Trauma Centre ◽

P Value ◽

Medication History ◽

Allied Health Professionals ◽

Essential Information ◽

Major Trauma Centre ◽

Good Patient Care ◽

The Uk

Abstract Introduction High quality medical records are integral to Good Medical Practice in the UK, for provision of good patient care. This study assesses the effectiveness of a structured Surgical Assessment Proforma in improving documentation, within the Surgical Assessment Unit (SAU) of a major trauma centre. Method A four-phase prospective study was undertaken – using PDSA methodology. This included: initial clinician survey and proforma development, audit, re-audit post-implementation, and final user survey. Evaluation and proforma design utilised standards from the RCS(Eng) and the PRSB. Notes of all patients admitted to the SAU, over two separate one-week periods, were assessed for completeness of documentation. Statistical analysis employed T-Test, with a P value of < 0.05 considered significant. The study was considered service evaluation, and therefore exempt from ethical approval. Results Pre-Proforma Survey 100% of respondents felt a proforma would be beneficial. 77% believed key elements of clerking were missed within the previous system. Cycle 1 (n = 62) Of note, assessment categories lacking information were: Responsible Consultant, Medication History, Allergy Status and Differential Diagnosis. Cycle 2 (n = 119) Of 45 assessment criteria: 38 improved (23 significantly (P < 0.05)), 2 showed no change, 5 were reduced (2 significantly (P < 0.05)). Documentation rates in nine categories improved by over 50%. Post-Proforma Survey 73% of doctors and 86% of allied health professionals (AHPs) agreed documentation improved with proforma use. 66% of clinicians agreed proformas reduced omission of essential information and provided safe clerking guidance for doctors. 100% of AHPs agreed the proforma improved handover. Conclusions In a major trauma centre SAU, standardised proforma use improves completeness of clerking.

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40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0068.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 330-338 ◽

Cited By ~ 1

Author(s):

Bisola Ajayi ◽

Alex Trompeter ◽

Magnus Arnander ◽

Philip Sedgwick ◽

Darren F. Lui

Keyword(s):

Clinical Characteristics ◽

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Group A ◽

Group B ◽

The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

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