Musculoskeletal Attendances to a Minor Injury Department During a Pandemic

Abstract

Introduction: As coronavirus disease 2019 (COVID-19) became a public health emergency of international concern, countries across the globe began to instate strict social distancing restrictions or “lockdowns”. During these times emergency departments in the United Kingdom (UK) recorded a significant drop in patients attending when compared to the same months of previous years. Attendances related to musculoskeletal (MSK) trauma also saw a significant drop in numbers Objective: The purpose of this retrospective audit was to investigate patterns of injuries attending during the pandemic and more specifically during times of lockdown. Method: Retrospective audit data was collected from an electronic medical record system (MediTech V6) during the time period of the first lockdown in the UK. Data was collected for patients attending the emergency department at the Queens Hospital Burton site of the University Hospitals of Derby and Burton National Health Service (NHS) Trust. Presenting complaints were recorded for the entire emergency department, and diagnosis on discharge and activity status was recorded for minor injuries only. This data was then compared to the same date from 2019. Results: Overall attendances in the emergency department decreased by 45.42% during the first lockdown when compared to the same time period in 2019. MSK problems also saw a significant drop as back pain decreased by 58.88%, neck pain fell by 78.52% and limb problems decreased by 59.74%. When comparing data from the minor injury department, limb problems decreased by 20.45%. The number of soft tissue injuries decreased by 24.05% and fractures decreased by 7.96%. Conclusion: Attendances in the emergency department were greatly reduced during the COVID-19 pandemic, especially during the first lockdown. The rates of fractures and soft tissue injuries within the minors’ area of the emergency department were also reduced but not at the same rate as the overall attendance. A large number of fractures and soft tissue injuries still presented to the emergency department despite reduced national activity. These attendances may be as a result of the increased rate of Do It Yourself (DIY)-related injuries and altered patient/social behaviour due to lockdown, social distancing, and seasons/weather. Further research would be required to investigate the changing patterns of behaviour especially as we enter a second wave of cases.

Differential diagnosis in children with musculoskeletal pain in Emergency Department

“…The duration of symptoms before admission was longer than in previous years but the difference was not significant. Our conclusions are confirmed by data from the United Kingdom and Italy, where a significant drop in attendances at HED in both children and adults due to musculoskeletal pain was observed during pandemic [32,33]. Some reports present neurological and musculoskeletal symptoms in patients with COVID-19, including myalgia (19% ) and back pain (10%) [34].…”

“…To our knowledge, none of the published studies have provided separate data on children with musculoskeletal pain in HED during the COVID-19 pandemic, although for adults or collective were presented [31][32][33]. During the pandemic fewer patients with musculoskeletal pain reported to our HED.…”

Effect of the COVID-19 Pandemic on Musculoskeletal Care in the Emergency Room

“…5 Some studies have specifically looked at ER encounters related to MSK health conditions during the pandemic and reported a reduction in the total number of encounters. [6][7][8] This decline ranged between 45.4% and 86.1% when compared with the same time period in the calendar year 2019.…”

“…A smaller study conducted in an ER in the United Kingdom showed an overall 45.4% reduction in attendance during the lockdown in 2020 when compared to 2019, including a reduction of 58.9% and 78.5% of patients in patients presenting with back pain and neck pain, respectively. 7 The mean age of the patients increased by 5 years, and the number of encounters associated with road accidents was reduced from 70 to 8. Another large study conducted in a large trauma center in France also reported a reduction (52.1%) in MSK encounters in the ER.…”

The Use of Fluoroscan in Hand Clinic During the Covid Pandemic to Optimise Conservative Treatment

“…Re-deployed referral patterns changed during COVID because patients with certain hand injuries increased as more patients fell while cycling or were injured in DIY-related accidents [6,8]. Practices evolved to adapt to non-operative management pathways by using Fluoroscan (Hologic, Inc., Marlborough, MA) in the hand clinic without compromising the standard of care by manipulating more fractures in outpatients rather than main theatres or day-case facilities.…”