Abstract
AimsTo analyse the learning points from the first 30 days of the COVID-19 lockdown at our institution.Patients & methodsFollowing ethical approval, data were collected prospectively on all patients admitted under orthopaedics between March 23, 2020, and April 22, 2020. This included baseline demographics (sex, age), biochemical (blood tests), radiological (chest X-ray (CXR), computed tomography (CT)), nature and mechanism of injury, comorbidities, regular medication, observations, specific respiratory symptoms of COVID-19, management, operations, time to theatre, and outcome including mortality incidence. The nature of injury and operations performed were compared to the same period of the previous year (2019).ResultsDuring the study period, 162 (74 males) patients were admitted, with a mean age of 60.7 (range 1-101, SD 2.1). On admission, 66 (41%) patients were tested for COVID, out of which eight (13.7%) patients tested positive. Subsequently, another four patients tested positive, who developed symptoms after admission. Four out 12 (33%) confirmed COVID patients died. During this period, 4/150 other patients also died of other causes (mortality incidence 2.6%). The average ages of COVID non-survivors vs survivors were 88, SD 1, vs 76, SD 12, respectively; 2/4 had concurrent diabetes and cancer, another cancer alone, and another complex autoimmune disease managed by immunosuppressive medication.Overall admissions significantly reduced by almost 50% compared with the previous year (162 vs 373, p=<0.05), including cases of polytrauma (15 vs 33). Time to surgery was increased by an average of one day, mainly due to time taken for COVID-19 swab results to come back, and in positive patients, this was an average of 2.75 days (0-13). Lymphopenia was a useful biomarker of COVID, with levels significantly different between groups (p=<0.05). Of the clinical symptoms assessed, 8/12 patients experienced positive chest symptoms or pyrexia but only four had positive CXR changes.Discussion & lessons learntEight out of 12 patients who contracted COVID-19 survived without needing intensive care. Non-survivors were older with significant comorbidities. Lymphopenia is a good biomarker of the disease, but suspicious CXR was not sensitive for excluding it. Trauma volume reduced. We have highlighted significant changes to expect should there be a second wave of the virus. Key lessons learnt were that reduction in trauma volume and cessation of elective operating allowed for redeployment, including taking over the minor injury unit; more senior, consultant decision-makers ‘at the front door’ reduced unnecessary admissions. Increased use of conservative practice was effective at reducing operations required. Expedited COVID swab test processing allowed early de-escalation of isolation, reducing time to surgery. We expect approximately 12% of the typical orthopaedic population to be admitted with COVID, and up to 33% of these patients to die within 28 days of contracting the virus. The vast majority of patients, however, can be managed appropriately with ward-level care. An early decision on escalation and resuscitation status in the emergency department improves patient flow significantly. Remote working was effective and could be extended in the future.We have highlighted the significant changes to expect should there be a second wave of the virus and effective solutions for managing the problems that arise, which could be useful for other units.
Highlights
How to cite this article Andrzejowski P A, Howard A, Vun J, et al (November 18, 2020) COVID-19: The First 30 Days at a UK Level 1 Trauma Centre and Lessons Learnt
66 (41%) patients were tested for COVID, out of which eight (13.7%) patients tested positive
Fair to say that the data we have presented comes from the ‘peak’ of the crisis, and lessons learnt from this would be applicable should there be a ‘second peak’ in the coming months, as it is likely that we could expect a similar number of cases in our unit
Summary
How to cite this article Andrzejowski P A, Howard A, Vun J, et al (November 18, 2020) COVID-19: The First 30 Days at a UK Level 1 Trauma Centre and Lessons Learnt. From January 2020, the demands and delivery of health care internationally changed significantly due to the COVID-19 virus. Late in 2019, 27 patients suffering from pneumonia of unknown aetiology were being treated in Wuhan City, China. The patients presented with a dry cough, dyspnoea, fever and bilateral lung infiltrates on chest radiograph [1]. The common denominator in these patients was a seafood wholesale market, trading in fish and a number of live animal species, including bats, marmots and snakes [2]. By January 7, 2020, the Chinese Centre for Disease Control and Prevention had identified the causative agent, the World Health Organisation (WHO) had named the disease COVID-19 [3]. COVID-19 is a zoonotic virus that causes severe acute respiratory syndrome [4]
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