Abstract
BackgroundConcerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients.Materials and methodsThis retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019–30 June 2019 were in the “pre-pandemic” group, patients were admitted 16 March 2020–30 June 2020 were in the “pandemic” group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality.ResultsThere were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04.ConclusionsWhile time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.
Highlights
Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients
There was a total of 703 patients admitted, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic, the proportion of admissions due to a hip fracture was similar between groups, p = 0.14
This study demonstrated that while the time from hip fracture injury to hospital arrival was statistically longer during COVID-19, the difference was only 11.5 min and was not clinically profound
Summary
Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The USA issued national social distancing guidelines on 16 March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic [1, 2]. Concerns of contracting the highly contagious disease COVID-19 have led to reluctance in seeking medical care, which may be contributing to delayed hospital arrival for patients with traumatic injuries. The pandemic has caused psychological responses such as fear, especially in the geriatric population, which could be attributable to increased mortality for geriatric patients who contract COVID-19 [8,9,10,11,12,13,14].
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