Trends in Ankle Sprains Presenting to Emergency Departments During the COVID-19 Pandemic

Abstract

Category: Trauma; Ankle Introduction/Purpose: It has been suggested that the COVID-19 pandemic has led to patients deferring evaluation and treatment of injuries due to fear of contagion. This, in addition to lockdowns and avoidance of outside activities, may have led to a decrease in the recorded incidence of activity-related injuries. The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on Emergency Department (ED) visits for ankle sprains in the United States, including incidence, demographics, and etiology. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to EDs in the U.S. for ankle sprains between 2001-2020. Population estimates were derived from the U.S. Census Bureau from 2001- 2020 for calculation of incidence in person-years. Chi-square analysis and Wald chi-square tests were performed to assess differences between pre-pandemic (2001-2019) and during-pandemic (2020) periods. Results: Between 2001 and 2020, a total of 315,545 actual ankle sprains were identified in the NEISS database for an estimated 11,904,243 ankle sprains (610,445.2 per year) among a population at risk of 6,185,494,962 person-years. The estimated incidence of ankle sprains in the general population presenting to EDs was 1.92 per 1000 person-years. When analyzing pre- and during- pandemic cohorts, ankle sprain incidence was significantly lower during-pandemic (1.98 vs 0.89 per 1000 person-years; P<0.001). Additionally, patients that visited EDs for ankle sprains during the pandemic were older (30.5% vs 27.0%; P<0.001), more likely to be female (57.8% vs 51.8%; P<0.001), and more likely to be Asian (0.83% vs 0.44%; P=0.047), Native American (0.62% vs 0.18%; P=0.001), or of Pacific Islander race (0.13% vs 0.04%; P=0.008). Ankle sprains were due to sport-related activities in 38% of patients pre-pandemic, as opposed to 29% of patients during-pandemic (P<0.001). Conclusion: The incidence of ankle sprains decreased 65% in 2020, probably owing to activity restrictions during the COVID-19 pandemic. This was further supported by a significant decrease in the proportion of ankle sprains due to sport-related activities. Finally, changes in age, gender, and racial patterns were also identified for this injury type.