医院安全吗？一项关于 SARS-CoV-2 患病率和手术骨折患者结局的前瞻性研究：对髋部骨折患者的更深入观察。
Are Hospitals Safe? A Prospective Study on SARS-CoV-2 Prevalence and Outcome on Surgical Fracture Patients: A Closer Look at Hip Fracture Patients.
机构信息
Departments of Orthopaedic Surgery, and.
Microbiology, Hospital Universitario de La Ribera, Alzira, Valencia, Spain.
出版信息
J Orthop Trauma. 2020 Oct;34(10):e371-e376. doi: 10.1097/BOT.0000000000001899.
OBJECTIVES
To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic.
DESIGN
Longitudinal prospective cohort study.
SETTING
Level I Trauma Center in the East of Spain.
PATIENTS/PARTICIPANTS: One hundred forty-four consecutive fracture patients 18 years or older admitted for surgery.
INTERVENTION
Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19.
MAIN OUTCOME MEASUREMENTS
Patients were interviewed and charts reviewed for demographic, epidemiological, clinical, and surgical characteristics.
RESULTS
We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other 2 required admission due to COVID-19-related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (P = 0.025) and intimate exposure to SARS-CoV-2-positive patients (P = 0.013). No association was found when crowding above 50 people was tested individually (P = 0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (P = 0.034).
CONCLUSIONS
Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
描述骨折患者的临床特征，包括更详细地观察髋部骨折患者，并确定流行病学变量如何影响对 SARS-CoV-2 感染的更高易感性，为大流行期间重新引入择期手术提供依据。
设计
前瞻性队列研究。
地点
西班牙东部一级创伤中心。
患者/参与者：144 例 18 岁或以上因手术而入院的连续骨折患者。
干预
患者接受 SARS-CoV-2 分子和/或血清学检测，并筛查 COVID-19 症状。
主要观察指标
对患者进行访谈并查阅病历，记录人口统计学、流行病学、临床和手术特征。
结果
我们对所有患者进行了访谈并对 137 例（95.7%）进行了检测。发现 3 例 SARS-CoV-2 阳性患者（2.1%）。1 例无症状，另 2 例因 COVID-19 相关症状需要住院治疗。全队列死亡率为 13 例（9%）。SARS-CoV-2 感染与包括与呼吸道症状患者密切接触（P=0.025）和与 SARS-CoV-2 阳性患者密切接触（P=0.013）等流行病学变量存在显著相关性。当单独测试超过 50 人的拥挤程度时，未发现相关性（P=0.187）。比较 2020 年和 2019 年髋部骨折患者队列时，发现它们在包括 30 天死亡率在内的方面相似。2020 年患者的手术延迟从 1.5 天增加到 1.8 天，差异有统计学意义（P=0.034）。
结论
如果严格遵守建议，患者可以在医院安全地接受治疗。髋部骨折患者的两个队列都有相似的 30 天死亡率。
证据水平
预后 III 级。有关证据水平的完整描述，请参见作者说明。
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