The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre

Abstract

Introduction Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. Materials and methods We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. Results There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. Discussion There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. Conclusion While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential ‘second wave’ of COVID-19.

Impact of the COVID-19 Pandemic on Trauma Service Utilization at a New York City Level I Trauma Center

“…Of note, while some literature has shown a higher incidence of anxiety and depression during the COVID-19 pandemic, our data showed no change in trauma activations secondary to self-harm. 25 It was posited that the increased incidence of depression and anxiety may lead to increased self-harm, but this trend was not witnessed at our trauma center.…”

Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis

“…While these orders had a relatively positive impact on reducing COVID-19 infections (Woskie et al 2021;Wellenius et al 2021;Fraser et al 2021), increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. For instance, Stayat-Home orders in the USA have been associated with decreases in emergency department (ED) visits (Jeffery et al 2020;Keyes et al 2021), trauma admissions (Chiba et al 2021;Kamine et al 2020), and motor vehicle collisions (MVCs) (Chiba et al 2021;Devarakonda et al 2021;Sherman et al 2021;Sutherland et al 2020) as well as increases in suicide/suicidal attempts (Chiba et al 2021;Czeisler et al 2020;Hay et al 2021;Hill et al 2021), firearm injuries (Chiba et al 2021;Sherman et al 2021;Hatchimonji et al 2020;Yeates et al 2021), and domestic violence/child abuse (Kovler et al 2021;Evans et al 2020;Hsu and Henke 2021).…”

Effect of Stay-at-Home Orders and Other COVID-Related Policies on Trauma Hospitalization Rates and Disparities in the United States: A Statewide Time-Series Analysis

“…While these orders had a relatively positive impact on reducing COVID-19 infections(1-3), increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. For instance, Stay-at-Home orders in the United States have been associated with decreases in emergency department (ED) visits (4,5), trauma admissions(6, 7), and motor vehicle collisions (MVCs)(6, 8-10) as well as increases in suicide/suicidal attempts(6, [11][12][13], rearm injuries(6, 9,14,15), and domestic violence/child abuse(16-18). Despite trauma patients having presumed equal access to healthcare and the highly protocolized nature of trauma management plans, racial and ethnic disparities in the United States were prevalent in traumatic injury prior to the COVID-19 pandemic (19,20).…”