Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan ROC.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Apr 1;84(4):423-427. doi: 10.1097/JCMA.0000000000000503.
Coronavirus disease 2019 (COVID-19) posed a major threat to the clinical practice of orthopedic surgeons, especially in the emergency department. We aim to present: (1) the criteria established by the Surgery Management Committee of Taipei Veterans General Hospital in response to COVID-19 and (2) the impact of COVID-19 screening on orthopedic trauma patients in the emergency department.
From April 1 to April 30, 2020, all orthopedic trauma patients in the emergency department were screened for COVID-19 if they fulfilled any of the following: (1) travel from abroad within 14 days, (2) high-risk occupation, (3) contact or cluster history with a COVID-19-positive patient, and (4) any associated symptom, including fever up to 38°C, cough, sore throat, rhinorrhea, loss of taste or smell, muscle soreness, malaise, or shortness of breath. We recorded details on the injury, fever, management, and associated outcomes.
Of the 163 orthopedic trauma patients presenting to the emergency department, 24 were screened for COVID-19; of these, 22 received surgery. Sixty-two patients received surgery without screening for COVID-19. Fever was the most common reason to screen for COVID-19 (N = 20; 83.3%). No patients were COVID-19 positive. Screened patients had a significantly longer mean interval from presentation to the emergency department to surgery (2.7 ± 2.5 vs. 1.5 ± 0.8 days, p = 0.037). Of the 20 patients screened because of fever, the focus was not identified in 12 (60.0%) patients. The other eight had urinary tract infection (N = 6; 27.2%), septic hip (N = 1; 4.6%), and concomitant pneumonia and urinary tract infection (N = 1; 4.6%). The mean duration of fever and hospital stay was 4.3 ± 4.6 and 8.7 ± 4.9 days, respectively. There were no thromboembolic events, surgical complications, or in-hospital mortality.
We developed safe and reliable screening criteria for this COVID-19 pandemic. The delay in surgery was reasonable and did not adversely affect in-patient outcomes.
2019 年冠状病毒病（COVID-19）对骨科医生的临床实践构成了重大威胁，尤其是在急诊科。我们旨在介绍：（1）台北荣民总医院外科管理委员会针对 COVID-19 制定的标准；（2）COVID-19 筛查对急诊科骨科创伤患者的影响。
2020 年 4 月 1 日至 4 月 30 日，满足以下任何一项标准的急诊科骨科创伤患者均接受 COVID-19 筛查：（1）14 天内从国外旅行；（2）高危职业；（3）与 COVID-19 阳性患者有接触或集群史；（4）任何相关症状，包括体温高达 38°C、咳嗽、喉咙痛、流鼻涕、味觉或嗅觉丧失、肌肉酸痛、不适或呼吸急促。我们记录了损伤、发热、管理和相关结果的详细信息。
163 例急诊科骨科创伤患者中，有 24 例接受了 COVID-19 筛查；其中 22 例行手术。62 例未接受 COVID-19 筛查而行手术。发热是最常见的 COVID-19 筛查原因（N=20；83.3%）。没有患者 COVID-19 阳性。接受筛查的患者从急诊科就诊到手术的平均间隔时间明显更长（2.7±2.5 天 vs. 1.5±0.8 天，p=0.037）。20 例因发热接受筛查的患者中，有 12 例（60.0%）患者未发现病因。其余 8 例患者分别患有尿路感染（N=6；27.2%）、脓毒性髋部感染（N=1；4.6%）和同时合并肺炎和尿路感染（N=1；4.6%）。发热和住院时间的平均持续时间分别为 4.3±4.6 天和 8.7±4.9 天。无血栓栓塞事件、手术并发症或院内死亡。
我们为本次 COVID-19 大流行制定了安全可靠的筛查标准。手术延迟是合理的，并未对住院患者的预后产生不利影响。
