Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

Abstract

Background The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. Methods All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). Findings Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. Conclusions While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

Injury burdens and care delivery in relation to the COVID-19 pandemic in Kigali, Rwanda: A prospective interrupted cross-sectional study

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Factors affecting 30-day postoperative complications after emergency surgery during the COVID-19 outbreak: A multicentre cohort study

“…The increase in trauma surgical procedures occurred in the second half of the first wave of the COVID-19 pandemic. This increase may result from an increase in falls and household injuries, which was seen in other studies ( 25 , 26 , 27 ). Additionally, an increase in bicycle accidents during the lockdown, as described previously, may be attributed to the increase in surgical trauma procedures as well ( 27 ).…”

“…This increase may result from an increase in falls and household injuries, which was seen in other studies ( 25 , 26 , 27 ). Additionally, an increase in bicycle accidents during the lockdown, as described previously, may be attributed to the increase in surgical trauma procedures as well ( 27 ). Especially since Dutch residents cycle frequently and increased recreational cycling was observed during the pandemic ( 28 ).…”

Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center

“…Overall there was a one third decrease of patients treated at our ED due to musculoskeletal problems, which was mainly due to a decreasing number of patients not requiring acute inpatient treatment. This decrease of emergency patients is in line with other studies from other level one trauma centers in Germany which reported a similar reduction in emergency patients [ 5 – 7 ]. A similar extent of the reduction in presentations was also found in a study from Spain.…”

“…In accordance with these findings Maleitzke et al showed a decrease in the incidence proportions of patients presenting to the ED with non-traumatic orthopedic symptoms during the shutdown period. More specifically a decrease of patients presenting with unspecific pain was found [ 7 ]. In the present study in comparison to 2019, a significant decline in presentations due to back pain could be found in 2020.…”