IMPACT-Scot report on COVID-19 and hip fractures

Abstract

<jats:sec><jats:title>Aims</jats:title><jats:p> The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A national multicentre retrospective study was conducted of all patients presenting to six trauma centres or units with a hip fracture over a 46-day period (23 days pre- and 23 days post-lockdown). Patient demographics, type of residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, operation, American Society of Anesthesiologists (ASA) grade, anaesthetic, length of stay, COVID-19 status, and 30-day mortality were recorded. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of 317 patients with acute hip fracture, 27 (8.5%) had a positive COVID-19 test. Only seven (26%) had suggestive symptoms on admission. COVID-19-positive patients had a significantly lower 30-day survival compared to those without COVID-19 (64.5%, 95% confidence interval (CI) 45.7 to 83.3 vs 91.7%, 95% CI 88.2 to 94.8; p &lt; 0.001). COVID-19 was independently associated with increased 30-day mortality risk adjusting for: 1) age, sex, type of residence (hazard ratio (HR) 2.93; p = 0.008); 2) Nottingham Hip Fracture Score (HR 3.52; p = 0.001); and 3) ASA (HR 3.45; p = 0.004). Presentation platelet count predicted subsequent COVID-19 status; a value of &lt; 217 × 10<jats:sup>9</jats:sup>/l was associated with 68% area under the curve (95% CI 58 to 77; p = 0.002) and a sensitivity and specificity of 63%. A similar number of patients presented with hip fracture in the 23 days pre-lockdown (n = 160) and 23 days post-lockdown (n = 157) with no significant (all p ≥ 0.130) difference in patient demographics, residence, place of injury, Nottingham Hip Fracture Score, time to surgery, ASA, or management. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> COVID-19 was independently associated with an increased 30-day mortality rate for patients with a hip fracture. Notably, most patients with hip fracture and COVID-19 lacked suggestive symptoms at presentation. Platelet count was an indicator of risk of COVID-19 infection. These findings have implications for the management of hip fractures, in particular the need for COVID-19 testing. </jats:p></jats:sec>

Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology

“…Additionally, we did not analyse preoperative and post-operative laboratory results in this series. Hall et al suggest that platelet count at admission was useful to predict subsequent COVID-19 status [12]. In this sense, we were able to correlate our findings only with the prolonged mandatory lockdown established in our country and not with the virus per se.…”

“…Although this issue is likely multifactorial, we believe that social lockdown had a significant influence, regardless of new clinical pathways specifically designed for hip fracture care during the pandemic. Hall et al recently reported that apart from the length of stay, no significant differences in pre-and post-lockdown hip fracture patients were detected, including demographic characteristics, Nottingham Hip Fracture Score, time to surgery, ASA score or fracture management [12]. Therefore, and to our knowledge, our study is the first to report a true epidemiological impact of COVID-19 mandatory lockdown on hip fracture care.…”

“…Patients were not transferred to their corresponding bed/floor until the test was ready. Median time to rRT-PCR results was six hours (interquartile range [IQR], [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. No surgeries were performed with a pending rRT-PCR result.…”

“…Similarly, some have reported on the influence of prolonged mandatory quarantine on hip fracture epidemiology and mortality rate, independently of testing positive or not for SARS-CoV-2 [12,13]. Prolonged lockdowns have restricted physical activity as well as health care access and surveillance of chronic medical conditions [14].…”

Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture – A systematic review and meta-analysis

“…Patients with hip fractures are among the highest risk groups for developing severe COVID-19, because they are typically elderly, have disproportionate body composition, lower bone mineral density, and reduced mobility, and frequently suffer from chronic illnesses. 2 , 3 , 4 , 5 , 6 , 7 …”