Main Article Content
COVID-19, SARS-CoV-2, Epidemiology, Orthopedic, Trauma, Fracture
Background: The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system. Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation. Materials and methods: We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport. Result: The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, signiﬁcantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively). Conclusion: Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.
2. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. [Internet]. 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
3. Lv H, Zhang Q, Yin Y, et al. Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study. Injury. 2020;51:1698-1704.
4. Yan Y, Zhu Y, Lian X, et al. A comparative epidemiologic study of fractures among people in rural and urban areas. Injury. 2020;51:1784-1790.
5. Nuñez JH, Sallent A, Lakhani K, et al. Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain. Injury. 2020;51:1414-1418.
6. Park C, Sugand K, Nathwani D, et al.. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month". Acta Orthop. 2020;1-6.
7. Benazzo F, Rossi SMP, Maniscalco P, et al. The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. Int Orthop. 2020;44:1453-1459.
8. Gilat R, Cole BJ. COVID-19, Medicine, and Sports. Arthrosc Sports Med Rehabil. 2020;2:e175-e176.
9. Bellan M, Gavelli F, Hayden E, et al. Pattern of emergency department referral during the Covid-19 outbreak in Italy. Panminerva Med. 2020;10.23736/S0031-0808.20.04000-8.
10. Maniscalco P, Poggiali E, Quattrini F, et al. The deep impact of novel CoVID-19 infection in an Orthopedics and Traumatology Department: the experience of the Piacenza Hospital. Acta Biomed. 2020;91:97-105.
11. Pichard R, Kopel L, Lejeune Q, et al. Impact of the COronaVIrus Disease 2019 lockdown on hand and upper limb emergencies: experience of a referred university trauma hand centre in Paris, France. Int Orthop. 2020;44:1497-1501.
12. Zagra L, Faraldi M, Pregliasco F, et al. Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: a seven-week observational analysis. Int Orthop. 2020;44:1591-1598.
13. Ceylan Z. Estimation of COVID-19 prevalence in Italy, Spain, and France. Sci Total Environ. 2020;729:138817.
14. Kamine TH, Rembisz A, Barron RJ, et al. Decrease in Trauma Admissions with COVID-19 Pandemic. West J Emerg Med. 2020;21:819-822.
15. Christey G, Amey J, Campbell A, Smith A. Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. N Z Med J. 2020;133:81-88.
16. Gumina S, Proietti R, Polizzotti G, et al. The impact of COVID-19 on shoulder and elbow trauma: an Italian survey. J Shoulder Elbow Surg. 2020;29:1737-1742.