Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

Abstract

Background: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive.

Methods: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs).

Findings: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively.

Conclusions: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

Fig 1. Longitudinal time chart of analyzed time frames before, during and after the COVID-19 shutdown in Berlin, Germany.

CTRL = Control; PRE = pre shutdown transition; POST = post shutdown transition; SHUTDOWN = shutdown.

Fig 2. Daily total cases, contacts and orthopedic trauma cases before, during and after the COVID-19 shutdown.

A–C: Number of daily (A) total cases, (B) total contacts and (C) orthopedic trauma cases day by day during the four defined periods. Dotted lines indicate the CTRL period in 2019, solid lines indicate PRE, SHUTDOWN and POST periods in 2020. D–F: Box-whisker plots show the number of daily (D) total cases, (E) total contacts and (F) orthopedic trauma cases during the four different periods. CTRL = control; PRE = pre shutdown transition; POST = post shutdown transition; SHUTDOWN = shutdown.

Fig 3. Plots showing RRs during the SHUTDOWN compared to the CTRL period for selected outcomes.

(A) Demographic specifics, trauma calls, deaths and substance abuse, (B) trauma causes within private environments and (C) within traffic and workplace environments. Circles indicate RRs (SHUTDOWN vs. CTRL) and whiskers the 95% CIs.

Fig 4. Plots showing RRs during the SHUTDOWN compared to the CTRL period for selected outcomes.

(A) Non-traumatic orthopedic visits, (B) treatment and (C) discharge metrics. Circles indicate RRs (SHUTDOWN vs. CTRL) and whiskers the 95% CIs. ED = emergency department.

Fig 5. Plot showing RRs during the SHUTDOWN compared to the CTRL period for fractures and patients with intracranial hemorrhages.

Circles indicate RRs (SHUTDOWN vs. CTRL) and whiskers the 95% CIs. Numbers are presented in Table 3.