The concept of frailty is one which is gaining increasing attention due to its multifactorial constituents, and its impact on geriatric patient care. This retrospective analysis of cardiopulmonary resuscitation (CPR) in Maltese Hospitals aims to determine the significance of frailty in relation to CPR outcome in one calendar year. In this study, we analysed the outcome of cardiopulmonary resuscitation (CPR) in Maltese Hospitals for the year 2019 in relation to frailty status using the Charlson Comorbidity Index (CCI). 185 eligible patients were obtained from the CPR register after excluding patients <18years of age, peri-arrest cases, a test case, double-recorded CPR documents and patients with insufficient data recorded. From these 185 patients, the statistics were of 123 males and 62 females, with an age range of 26 years to 99 years. The median age was 78 years whilst mean age was 76.2 years. The majority of patients fell within CCI of 4-8 (143 patients), with the largest cohort obtaining a score of 6 (39 patients). The results highlight a low rate of ROSC (4.32%) irrespective of CCI score. However, when ROSC was achieved, survival to discharge was noted to be greater with lower CCI scores. Only 5 patients survived one year post discharge.This data is in keeping with other studies regarding CPR in frail patients, despite the use of other scores such as the Clinical Frailty Score. Smith et al’s study in Australian tertiary centres between 2008 and 2017 used the CCI, and points out a lower rate of discharge home in frail patients who survive an in-hospital cardiac arrest [1]. Limitations of our study include the small population, although exhaustive of the CPRs performed on the Maltese Islands in 2019.
The effect of banning of nonessential services during the novel coronavirus disease 2019 (COVID-19) pandemic led to a perceived change in the volume of trauma cases and injury patterns. Literature indicates trends toward less trauma overall, with a decrease in outdoor, sporting, and motor vehicle injuries. However, studies focusing on outpatient orthopaedic trauma are less common. The main aim of this study was to assess the effect of COVID-19 pandemic on differences in inpatient and outpatient injury patterns and mechanisms. Patients requiring orthopaedic inpatient admission to Mater Dei Hospital, Malta, were analyzed between March 15 and June 17 between 2019 and 2021. For outpatients, all newly referred patients seen at the fresh trauma clinic (FTC) on the first 5 clinic days of each month from April to June between 2019 and 2021 were assessed. There were a total of 503, 362, and 603 hospital admissions during the data collection period from 2019, 2020 and 2021, respectively. There was a decrease in elbow (p = 0.015) and pelvis (p = 0.038) pathology since COVID-19 pandemic. In contrast, there was an increase in shoulder injuries (p = 0.036) and lacerated wounds (p = 0.012) in 2021. The most frequent mechanisms of injury for inpatients were low impact falls, and fall from heights greater than 1 m. Machine-related injuries (p = 0.002), blunt trauma (p = 0.004), and twisting injuries (p = 0.029) increased in 2021. In the outpatient setting, there were a total of 367, 232, and 299 new referrals in 2019, 2020, and 2021, respectively. Injury patterns in this cohort were similar throughout, except for a significant increase in shoulder injuries during 2020 (p = 0.009). There appears to be some minor variation in injury mechanisms due to lifestyle changes; however, most injury patterns have remained fairly constant. Further research should focus on the use of public awareness campaigns to decrease home-related trauma during enforced periods of lockdown.
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