Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic

Abstract

Introduction In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. Methods All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge. Results Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households. Conclusion Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process. Cite this article: Bone Joint Open 2020;1-6:287–292.

The overall impact of COVID‐19 on healthcare during the pandemic: A multidisciplinary point of view

“… 129 However, in the study of Iliadis et al patients across different orthopedic subspecialties underwent the surgery without respiratory complications in the early postoperative period. 130 …”

Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary

“…These preparations for VC provided helpful groundwork for the rapid implementation process. The RNOH does not have an emergency department so was not subject to an immediate surge of patients with COVID-19, although the Trust did establish a new emergency orthopaedic trauma referral pathway enabling acute trusts to free up bed capacity elsewhere in London 5. There was also a strict limit on the type of activity that could take place at the hospital to help to minimise the spread of COVID-19.…”

Safety evaluation of providing trauma service during COVID-19 phase one lockdown

“…A recent study has shown that operating on a paediatric population during the peak of COVID-19 did not result in symptomatic spread of COVID-19 in any patient or their households. 4 Despite this, there were still concerns that children may be asymptomatic carriers. 5 , 6 , 7 Furthermore, some hospital institutions restarted elective orthopaedic surgery on green (non-covid) sites during the de-escalation phase and early results show that elective surgery is safe and had high satisfaction rates with adequate resources and appropriate infrastructure.…”