COVERT (COVid Emergency-Related Trauma and Orthopaedics: National and International Overview”)
King’s College Medical School
The COVERT collaborative, part of the RCS COVID-19 research group, is led by Dr Kapil Sugand. It has shed an important light on how both the adult (Park et al., 2020) and paediatric (Sugand et al., 2020) acute orthopaedic trauma referral caseloads and orthopaedic trauma operative casemixes at Level 1 Major Trauma Centres in Central London have been impacted by COVID-19.
The team carried out 2 longitudinal retrospective observational studies by comparing the caseloads and casemixes in a fixed period after the first national lockdown on 23rd March 2020 to that of the same period in the previous year 2019. Significant differences between the two periods were highlighted.
They found a reduction in acute trauma referrals post-lockdown of almost a half, but an 19% increase in number of referrals that required admissions (Park et al., 2020). This was attributed to the national social distancing measures that were implemented at the time, although there seemed to be a decreased threshold for requiring admission. They found an 11% increase in the proportion of acute referrals for hip fractures and polytrauma cases, with a 19% reduction in the proportion of acute referrals for isolated limb injuries (Park et al., 2020). This was attributed to an increase in the proportion of low-energy falls at home and multiple injuries in the construction industry or from DIY projects at home. They also found a reduction in the total number of operations by a third, with a 14% decrease in aerosol-generating anaesthetic procedures (Park et al, 2020). This was attributed to the reduction in acute trauma referrals and the shift away from procedures that carried an increased risk of viral transmission with increased viral loads.
Likewise, they found a reduction in acute paediatric trauma referrals post-lockdown of two-thirds, with a reduction in the proportion of acute referrals for sporting-related mechanism of injuries (Sugand et al., 2020). Again, this reduction was attributed to the national social distancing measures. They also found an increase in the proportion of outpatient telemedicine consultations, with an increase in the proportion of Virtual Fracture Clinics and a reduction in the proportion of number of face-to-face consultations (Sugand et al., 2020). In the same way, this was attributed to the shift away from practices that carried an increase risk of viral transmission.
It will be interesting to see if other Trauma Centres across the nation, and the globe, have experienced similar trends. We still have much to learn more about how our healthcare infrastructures have been affected by the pandemic, and whether these effects will be temporary or permanent.
Chang Park, Kapil Sugand, Dinesh Nathwani, Rajarshi Bhattacharya & Khaled M Sarraf (2020) Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the “golden month”, Acta Orthopaedica, DOI: 10.1080/17453674.2020.1783621.
Kapil Sugand, Chang Park, Catrin Morgan, Rory Dyke, Arash Aframian, Alison Hulme, Stuart Evans, Khaled M Sarraf & the COVERT Collaborative (2020) Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the “golden weeks”, Acta Orthopaedica, DOI: 10.1080/17453674.2020.1807092.