Emergency Department Visits for Ankle Fractures Through COVID-19: An Analysis of the National Electronic Injury Surveillance System

Abstract

Background:Societal changes that occurred during the COVID-19 pandemic may have altered the epidemiology of ankle fractures. The aim of this study was to assess trends in emergency department visits for ankle fractures from 2019 to 2020 in the United States.Methods:The National Electronic Injury Surveillance System (NEISS) database is a sample of hospitals in the United States stratified and weighted based on emergency department (ED) size, which was used to generate national estimates (NEs). The NEISS database was queried for patients who sustained an ankle fracture. Patients before COVID-19 (BC) (July 2019–December 2019) were compared to those during COVID-19 (DC) (July 2020–December 2020).Results:This study assessed 3350 (NE: 131,672) patients. Of these, 1683 (NE: 67,292) patients presented BC and 1667 (NE: 64,380) DC, representing a 4% decrease. The rate of alcohol-related ankle fractures increased (1.9% BC vs 2.6% DC; P < .001). The fraction of ankle fractures at school (3% BC vs 0.7% DC; P < .001) and during sports (19% BC vs 14% DC; P < .001) decreased. ED visits for ankle fracture leading to hospitalization marginally increased (23% BC vs 24% DC). The top 3 ankle fracture causes during COVID-19 were stairs (NE: 18,026, 28%), floors (ie, falling on floor) (NE: 4635, 7.2%), and skateboards (NE: 2832, 4.40%). The 3 largest increases in ankle fracture causes during COVID-19 were skateboards (+2.80%), floors (+1.10%), and powered scooters (+0.80%).Conclusion:There was a decrease in ankle fractures during the COVID-19 pandemic compared to the year before. Alcohol-related fractures increased as did fractures resulting in hospitalization. Ankle fractures caused by skateboards, powered scooters, and mopeds increased during COVID-19, whereas fewer occurred in school or during sports, consistent with restrictions to group activities. These findings may aid in proper health care budgeting in times of national and global crises.Level of Evidence:Level III, retrospective comparative study.