How the COVID-19 Pandemic Affected Attendance at a Tertiary Orthopedic Center Emergency Department: A Comparison between the First and Second Waves

Abstract

Italy was the first European country to face the SARS-CoV-2 virus (COVID-19) pandemic in 2020. The country quickly implemented strategies to contain contagions and re-organize medical resources. We evaluated the COVID-19 effects on the activity of a tertiary-level orthopedic emergency department (ED) during the first and second pandemic waves. We retrospectively collected and compared clinical radiological data of ED admissions during four periods: period A, first pandemic wave; period B, second pandemic wave; period C, three months before the COVID-19 outbreak; period D, same timeframe of the first wave but in 2019. During period A, we found a reduction in ED admissions (-68.2% and -59.9% compared with periods D and C) and a decrease in white codes (non-urgent) (-7.5%) compared with pre-pandemic periods, with a slight increase for all other codes: +6.3% green (urgent, not critical), +0.8% yellow (moderately critical) and +0.3% red (highly urgent, risk of death). We observed an increased rate of fracture diagnosis in period A: +14.9% and +13.3% compared with periods D and C. Our study shows that the COVID-19 pandemic caused a drastic change in the ED patient flow and clinical radiological activity, with a marked reduction in admissions and an increased rate of more severe triage codes and diagnosed fractures.

Keywords: COVID-19; emergency department; orthopedic radiology.

Figure 1

Visual comparison of the absolute percentages of patients’ age in the different periods. Period A: first pandemic wave; period B: second pandemic wave; period C: 1 December 2019–20 February 2020 (three months before the COVID-19 outbreak); period D: 21 February 2019–31 May 2019 (same timeframe of first wave but in 2019). * indicates statistical difference between period A and periods C/D for the group <40 years of age; # indicates statistical difference between period A and periods C/D for the group >61 years of age.

Figure 2

Visual comparison of the absolute percentages of triage code at discharge in the different periods. Period A: first pandemic wave; period B: second pandemic wave; period C: 1 December 2019–20 February 2020 (three months before the COVID-19 outbreak); period D: 21 February 2019–31 May 2019 (same timeframe of first wave but in 2019).

Figure 3

Visual comparison of the absolute percentages of t discharge destination in the different periods. Period A: first pandemic wave; period B: second pandemic wave; period C: 1 December 2019–20 February 2020 (three months before the COVID-19 outbreak); period D: 21 February 2019–31 May 2019 (same timeframe of first wave but in 2019).

Figure 4

Visual comparison of the absolute percentages of proximal femoral fractures, atraumatic pain and traumatic pain without a fracture in the different periods. Period A: first pandemic wave; period B: second pandemic wave; period C: 1 December 2019–20 February 2020 (three months before the COVID-19 outbreak); period D: 21 February 2019–31 May 2019 (same timeframe of first wave but in 2019).

Figure 5

Figure shows a frontal pelvis X-ray examination of an 87-year-old female patient who suffered a left pertrochanteric femoral fracture (arrow) that has been surgically treated with an intramedullary nail.

Figure 6

Figure shows a frontal and lateral knee X-ray examination of a 67-year-old male patient who suffered a non-displaced external left tibial plateau fracture (arrow) that has been treated conservatively with home-discharge after immobilization. Lateral X-ray shows mild knee post-traumatic effusion (asterisk).

Figure 7

Figure shows a frontal and lateral lumbar spine X-ray examination of a patient suffering from sciatica, which presents with diffuse spondylarthrosis with lower tract spinal canal stenosis, mild scoliosis and loss of intervertebral disc space at multiple levels (arrows). Spina bifida occulta is also suspected at L5 (dashed arrow). The presence of vertebral fracture was excluded by follow-up MRI examination (not shown).