Bram Joshua T, Johnson Mitchell A, Magee Lacey C, Mehta Nishank N, Fazal Faris Z, Baldwin Keith D, Riley Jake, Shah Apurva S
Division of Orthopaedics, The Children's Hospital of Philadelphia.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Pediatr Orthop. 2020 Sep;40(8):373-379. doi: 10.1097/BPO.0000000000001600.
During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of school and organized sports. A resulting change in pediatric fracture epidemiology is expected. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics.
This is a retrospective cohort study comparing acute fractures presenting to a single level I pediatric trauma hospital during the COVID-19 pandemic with fractures during a prepandemic period at the same institution. The "pandemic" cohort was gathered from March 15 to April 15, 2020 and compared with a "prepandemic" cohort from the same time window in 2018 and 2019.
In total, 1745 patients presenting with acute fractures were included. There was a significant decrease in the incidence of fractures presenting to our practice during the pandemic (22.5±9.1/d vs. 9.6±5.1/d, P<0.001). The presenting age for all fractures decreased during the pandemic (7.5±4.3 vs. 9.4±4.4 y, P<0.001) because of decreased fracture burden among adolescents. There were also a decrease in the number of fractures requiring surgery (2.2±1.8/d vs. 0.8±0.8/d, P<0.001). During the pandemic, there was an increase in the proportion of injuries occurring at home (57.8% vs. 32.5%, P<0.001) or on bicycles (18.3% vs. 8.2%, P<0.001), but a decrease in those related to sports (7.2% vs. 26.0%, P<0.001) or playgrounds (5.2% vs. 9.0%, P<0.001). There was no increase in time-to-presentation. Patients with distal radius torus fractures were more likely to receive a velcro splint during the pandemic (44.2% vs. 25.9%, P=0.010).
Pediatric fracture volume has decreased 2.5-fold during the COVID-19 pandemic, partially because of cessation of organized sports and decreased playground use. In endemic regions, lower trauma volume may allow redeployment of orthopaedic surgeons and staff to other clinical arenas. Given the rising proportion of bicycling injuries, an emphasis on basic safety precautions could improve public health. An observed increase in the prescription of velcro splints for distal radius fractures highlights an opportunity for simplified patient care during the pandemic.
Level III.
在新冠疫情期间，已实施鼓励社交距离的公共卫生措施，包括取消学校课程和有组织的体育活动。预计小儿骨折的流行病学将因此发生变化。本研究探讨了新冠疫情对骨折发生率和特征的影响。
这是一项回顾性队列研究，比较了新冠疫情期间一家一级小儿创伤医院收治的急性骨折病例与该机构疫情前同期的骨折病例。“疫情”队列收集于2020年3月15日至4月15日，并与2018年和2019年同一时间窗口的“疫情前”队列进行比较。
共纳入1745例急性骨折患者。疫情期间我院收治的骨折发生率显著下降（22.5±9.1/天 vs. 9.6±5.1/天，P<0.001）。由于青少年骨折负担减轻，疫情期间所有骨折患者的就诊年龄下降（7.5±4.3岁 vs. 9.4±4.4岁，P<0.001）。需要手术的骨折数量也有所减少（2.2±1.8/天 vs. 0.8±0.8/天，P<0.001）。疫情期间，在家中受伤（57.8% vs. 32.5%，P<0.001）或骑自行车时受伤（18.3% vs. 8.2%，P<0.001）的比例增加，但与运动（7.2% vs. 26.0%，P<0.001）或游乐场（5.2% vs. 9.0%，P<0.001）相关的受伤比例下降。就诊时间没有增加。疫情期间，桡骨远端青枝骨折患者更有可能接受弹力绷带夹板固定（44.2% vs. 25.9%，P=0.010）。
在新冠疫情期间，小儿骨折数量减少了2.5倍，部分原因是有组织的体育活动停止和游乐场使用减少。在流行地区，较低的创伤量可能使骨科医生和工作人员重新部署到其他临床领域。鉴于骑自行车受伤的比例上升，强调基本安全预防措施可改善公众健康。观察到桡骨远端骨折弹力绷带夹板固定的处方增加，这凸显了疫情期间简化患者护理的机会。
三级。
