Impact of the COVID-19 pandemic on the trauma and orthopaedic department at level one Major Trauma Centre in the republic of Ireland

The Coronavirus Disease (COVID-19) has been identified as the cause of a rapidly spreading respira- tory illness in Wuhan, Hubei Province, China in early December 2019. Since then, the free movement of people has decreased. The trauma-related injuries and the demand on the trauma and orthopaedic service would be expected to fall. The aim of this study to examine the impact of the COVID-19 pandemic on a level 1 Trauma Centre in the Republic of Ireland (ROI). Patients admitted to the Trauma & Orthopaedic (T&O) Department at Cork University Hospital (CUH) and the South Infirmary Victoria University Hospital (SIVUH), and their associated fracture patterns and management, between 01/03/20 and the 15/04/20 were documented and compared to the patient admissions from the same time period one year earlier in 2019. The total number of T&O operations performed decreased by 10.15% (P= 0.03)between the two time periods. The number of paediatric procedures fell by 40.32% (P= 0.15). Adult Distal radius and paediatric elbow fractures (excluding supracondylar fracture) increased by 88% and 13% (P= 0.19), (P= 0.04) respectively. Hip fractures remained the most common fracture-type admitted for surgery. The COVID-19 crisis has to lead to a decrease in the total numbers of trauma surgeries in a major trauma centre in the ROI. This decline is most evident in the number of paediatric and male adult patients presenting with fractures requiring operative management. Interestingly, fractures directly related to solo outdoor activities, such as running or cycling, as well as simple mechanical falls like ankle, distal radius, elbow, and hand fractures all increased. Irish males were more compliant with outdoors restrictions than females.

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Identifying the barriers and facilitators to transforming a university hospital into a Major Trauma Centre: a qualitative case study using the Theoretical Domains Framework

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-23-s2-a10 ◽

2015 ◽

Vol 23 (S2) ◽

Author(s):

Neil Roberts ◽

Fabiana Lorencatto ◽

Joanna Manson ◽

Jan Jansen

Keyword(s):

Major Trauma ◽

Qualitative Case Study ◽

Theoretical Domains Framework ◽

Trauma Centre ◽

Barriers And Facilitators ◽

University Hospital ◽

Major Trauma Centre

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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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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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The impact of trauma centre designation on open tibial fracture management

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609957416 ◽

2013 ◽

Vol 95 (3) ◽

pp. 184-187 ◽

Cited By ~ 10

Author(s):

J Stammers ◽

D Williams ◽

J Hunter ◽

M Vesely ◽

D Nielsen

Keyword(s):

Major Trauma ◽

Average Length ◽

Trauma Centre ◽

Tibial Fractures ◽

Open Tibial Fractures ◽

Major Trauma Centre ◽

Fracture Management ◽

Before And After ◽

Trauma Networks ◽

The Impact

Introduction The British Orthopaedic Association/British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines for the management of open tibial fractures recommend early senior combined orthopaedic and plastic surgical input with appropriate facilities to manage a high caseload. The aim of this study was to assess whether becoming a major trauma centre has affected the management of patients with open tibial fractures. Methods Data were obtained prospectively on consecutive open tibial fractures during two eight-month periods: before and after becoming a trauma centre. Results Overall, 29 open tibial fractures were admitted after designation as a major trauma centre compared with 15 previously. Of the 29 patients, 21 came directly or as transfers from another accident and emergency deparment (previously 8 of 15). The time to transfer patients admitted initially to local orthopaedic departments has fallen from 205.7 hours to 37.4 hours (p=0.084). Tertiary transferred patients had a longer hospital stay (16.3 vs 14.9 days) and had more operations (3.7 vs 2.6, p=0.08) than direct admissions. As a trauma centre, there were improvements in time to definitive skeletal stabilisation (4.7 vs 2.2 days, p=0.06), skin coverage (8.3 vs 3.7 days, p=0.06), average number of operations (4.2 vs 2.3, p=0.002) and average length of hospital admission (26.6 vs 15.3 days, p=0.05). Conclusions The volume and management of open tibial fractures, independent of fracture grade, has been directly affected by the introduction of a trauma centre enabling early combined senior orthopaedic and plastic surgical input. Our data strongly support the benefits of trauma centres and the continuing development of trauma networks in the management of open tibial fractures.

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Management of renal injury in a UK major trauma centre

Trauma ◽

10.1177/1460408618802997 ◽

2018 ◽

Vol 22 (1) ◽

pp. 26-31

Author(s):

Robert Torrance ◽

Abigail Kwok ◽

David Mathews ◽

Matthew Elliot ◽

Andrew Baird ◽

...

Keyword(s):

Renal Injury ◽

Major Trauma ◽

Trauma Centre ◽

University Hospital ◽

Research Network ◽

Renal Trauma ◽

High Grade ◽

Major Trauma Centre ◽

Renal Injuries

Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

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Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2018-000415 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000415 ◽

Cited By ~ 1

Author(s):

Lucinda Hollinshead ◽

Fiona Jones ◽

Lucy Silvester ◽

Paul Marshall-Taylor

Keyword(s):

Educational Intervention ◽

Major Trauma ◽

Integrated Approach ◽

Trauma Centre ◽

Self Management ◽

Management Support ◽

Allied Health Professionals ◽

Improvement Project ◽

Major Trauma Centre ◽

The Impact

More patients now survive multiple trauma injuries, but the level of long-term unmet needs is high. Evidence shows self-management support can improve patients ’ confidence to manage these needs but traditionally this support starts post-hospital. Starting self-management support early could prepare patients and families for successful transitions from hospital. The skills and commitment of clinicians have been shown to contribute to the success or failure of self-management approaches. The aim of this project was to explore the feasibility of integrating self-management support in an acute major trauma setting by evaluating the impact of an educational intervention on clinicians’ knowledge, attitudes and behaviours regarding self-management support and identifying any barriers and facilitators to integrating self-management into daily practice. Two improvement cycles were carried out over a 1-year period involving 18 allied health professionals (AHPs) in an acute major trauma centre in London, UK. An educational intervention, ‘Bridges Self-Management Programme’ was modified for the setting. The impact was evaluated using (1) a clinician questionnaire to evaluate knowledge and attitudes; (2) case reflection forms and (3) peer review to observe interactions to integrate self-management support. Questionnaire data were summarised and pre-training and post-training scores compared; the qualitative data from written case reflections, verbal and written feedback from training and group discussions was described and analysed thematically. The result of two improvement cycles has shown it was feasible to improve AHP’s knowledge, attitudes and change behaviours regarding self-management support in the acute trauma setting, but difficult to sustain change beyond 6 months. Key barriers such as the pressure to discharge patients and support within the wider multidisciplinary team (MDT) were identified. Facilitators included the introduction of a new key-worker, to enable shared team approaches and paperwork to involve patients and families in goal setting and treatment planning. The main learning was to ensure sustainability mechanisms from the outset, engage the wider MDT in training, and integrate self-management language and principles into team processes.

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

Bone & Joint Open ◽

10.1302/2633-1462.15.bjo-2020-0028.r1 ◽

2020 ◽

Vol 1 (5) ◽

pp. 137-143 ◽

Cited By ~ 13

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.

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