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Observational Study
. 2021 Feb;103(2):114-119.
doi: 10.1308/rcsann.2020.7026.

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

D Hay  1 , M S Jamal  1 , K Al-Tawil  1 , A Petohazi  1 , V Gulli  1 , N F Bednarczuk  1 , R Baldwin-Smith  1 , J Gibbons  2 , J Sinha  1
Affiliations
Observational Study

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

D Hay et al. Ann R Coll Surg Engl. 2021 Feb.

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.

Keywords: Bone fractures; COVID-19; Depression; Mental health; Pandemic; Trauma.

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Figures

Figure 1
Figure 1
COVID-19 period compared with non-COVID-19 period: summary of referrals, admissions and operations, 2019 and 2020
Figure 2
Figure 2
COVID-19 period compared with non-COVID-19 period: summary of psychiatric diagnosis and fracture plus psychiatric diagnosis, 2019 and 2020
See this image and copyright information in PMC

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