Impact of the COVID-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the 4-week pre-lockdown period and the 8-week lockdown period divided into two 4-week periods: early lockdown and late lockdown. There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19s wave lockdown.

Figure 1

Change in the weekly admissions for MSI in the ED at Nantes University Hospital (linear scale graph), and the weekly cumulative incidence of COVID-19 national and regional active cases and deaths (logarithmic scale bar graphs) between the PL and L periods The first vertical line refers to the national French lockdown on the 17th of March 2020. The second vertical line refers to the virtual break separating L1 (Early lockdown period) and L2 (Late lockdown period) on the 14th of April 2020. MSI: Musculoskeletal injury, ED: Emergency department, PL: Pre-lockdown (from 02/18/20 to 03/16/20), L: Lockdown (from 03/17/20 to 05/11/20), L1: Early lockdown, L2: Late lockdown.

Figure 2

Change in the weekly surgical procedures, peripheral inter-hospital transfers, and weekly admissions for MSI in the ED of Nantes regional University Hospital (linear scale graph). The first vertical line refers to the national French lockdown on the 17th of March 2020. The second vertical line refers to the virtual break separating L1 (Early lockdown period) and L2 (Late lockdown period) on the 14th of April 2020. MSI: Musculoskeletal injury, ED: Emergency department, PL: Pre-lockdown (from 02/18/20 to 03/16/20), L: Lockdown (from 03/17/20 to 05/11/20), L1: Early lockdown (from 03/17/2020 to 04/13/20), L2: Late lockdown (from 04/14/20 to 05/11/20).

Figure 3

Stacked bar graph representation of high severity trauma (ISS > 16) according to the mechanism and the PL, L1, and L2 periods, with significant differences in the Fisher’s exact test. Others: L1: one assault, one work accident; L2: one sports accident, one work accident. PL: Pre-lockdown (from 02/18/20 to 03/16/20), L: Lockdown (from 03/17/20 to 05/11/20), L1: Early lockdown (from 03/17/2020 to 04/14/2020), L2: Late lockdown (from 04/14/2020 to 05/11/2020); ISS: International Severity Score.