Emergency Department Visits for Ankle Fractures: Trends Through COVID-19

Abstract

Category: Ankle Introduction/Purpose: Ankle fractures are common and can potentially lead to devastating consequences if not treated appropriately. The aim of this study was to assess trends in incidence, presentation, causes, and final disposition of emergency department visits for ankle fractures from 2019 to 2020. Methods: The National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS databases contains variables such as age, race, drug use, alcohol use, location, disposition, cause, body part, and injury type. The NEISS database from 2001 to 2020 was queried for patients who sustained an ankle fracture. Two cohorts: before COVID-19 (BC) (July 2019 - Dec 2019) and during COVID-19 (DC) (July 2020 - Dec 2020) were compared. Results: This study assessed 3,350 (NE: 131, 672) total patients who presented to emergency departments around the United States. 1,683 (NE: 17,936) patients presented BC and 1,667 (NE: 64,380) DC, representing a 4% decrease compared to the year before. The median age was 44 (Interquartile Range (IQR) 24-62), with 60% (NE: 79,051) females. On bivariate analysis, the rate of alcohol related ankle fractures increased (1.9% BC vs. 2.6% DC; p<0.001). Further, the number of ankle fractures at school (3% BC vs. 0.7% DC; p<0.001) and during sports (19% BC vs. 14% DC) decreased. Emergency departments visits leading to hospitalization increased (23% BC vs. 24% DC). The top three causes of ankle fracture during COVID-19 were stairs (NE 18,026, 28%), floors (NE 4,635, 7.2%), and skateboards (4.40%). The three largest increases in ankle fracture etiologies 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. Drug related fractures increased as did those resulting in hospitalization. Fractures caused by skateboards, powered scooters, and mopeds experienced an increase during COVID-19.