Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain

  • Jorge H. Nuñez
    Correspondence
    Corresponding author.
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Department of Traumatology and Orthopedic Surgery, Mutua de Terrassa Hospital. Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain
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  • Andrea Sallent
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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  • Kushal Lakhani
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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  • Ernesto Guerra-Farfan
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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  • Nuria Vidal
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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  • Seper Ekhtiari
    Affiliations
    Division of Orthopaedic Surgery, Department of Surgery, Mc Master University, Hamilton, Ontario, Canada
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  • Joan Minguell
    Affiliations
    Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain

    Universitat Autónoma de Barcelona. Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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      Highlights

      • Contingency plans need to be careful when reallocating resources, and not assume that all trauma presentations will decrease during a State of Emergency.
      • Health problems such as osteoporotic hip fractures may in fact remain stable during the State of Emergency (implementation of stringent lock-down measures for the population).
      • Given that osteoporotic hip fractures are in elderly population with multiple comorbidities, operative delays may increase the risk of mortality as well as of nosocomial infections in this pandemic virus.

      Abstract

      Introduction

      The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals’ current service needs during this pandemic. The aim of this study was to provide an overview of the impact of the pandemic, and its corresponding State of Emergency, on a tertiary traumatology emergency service.

      Methods

      An observational study was performed at a tertiary hospital within the Spanish National Health System. Four different periods were studied, including the first 20 days of Spain's current State of Emergency, from March 14 to April 02, 2020 (Period 4). This period was compared to the 20-day period prior to the State of Emergency (Period 3), and to matching periods in the two previous years (Periods 1 and 2). A total of 6,565 patient visits were analyzed: 1909 in Period 1 (29.1%), 2161 in Period 2 (32.9%), 1983 in Period 3 (30.2%), and 512 in Period 4 (7.8%). Variables collected included patient age and sex, insurance type, discharge destination and reason for hospital admission.

      Results

      The patients’ mean age was 55.1 years old (Standard Deviation (SD): 22.1), and 51.8% were women (3495/6565). During the COVID-19 pandemic, there were significant reductions in total visits to the trauma emergency department, workplace accidents, traffic accidents and number of hospital admissions, particularly during Period 4. However, no statistically-significant differences were found in the number of osteoporotic hip fractures admitted between the four periods. The numbers of hospital admissions for osteoporotic hip fracture were 42 during Period 1, 41 during Period 2, 43 during Period 3 and 36 during Period 4.

      Conclusions

      While most traumatological presentations decreased in frequency over the course of the outbreak, the number of osteoporotic hip fractures remained stable. Thus, contingency plans in times of crisis need to be carefully targeted, and to keep in mind certain public health issues that do not decrease, despite a State of Emergency, like osteoporotic hip fractures.

      Keywords

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