From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava).
From the Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ont. (Tarchala, Bradley, Grant, Verma, Camp, Kelley); and the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ont. (Matava)
Can J Surg. 2024 Feb 6;67(1):E49-E57. doi: 10.1503/cjs.002723. Print 2024 Jan-Feb.
In March 2020, Ontario instituted a lockdown to reduce spread of the SARS-CoV-2 virus. Schools, recreational facilities, and nonessential businesses were closed. Restrictions were eased through 3 distinct stages over a 6-month period (March to September 2020). We aimed to determine the impact of each stage of the COVID-19 public health lockdown on the epidemiology of operative pediatric orthopedic trauma.
A retrospective cohort study was performed comparing emergency department (ED) visits for orthopedic injuries and operatively treated orthopedic injuries at a level 1 pediatric trauma centre during each lockdown stage of the pandemic with caseloads during the same date ranges in 2019 (prepandemic). Further analyses were based on patients' demographic characteristics, injury severity, mechanism of injury, and anatomic location of injury.
Compared with the prepandemic period, ED visits decreased by 20% (1356 v. 1698, < 0.001) and operative cases by 29% (262 v. 371, < 0.001). There was a significant decrease in the number of operative cases per day in stage 1 of the lockdown (1.3 v. 2.0, < 0.001) and in stage 2 (1.7 v. 3.0; < 0.001), but there was no significant difference in stage 3 (2.4 v. 2.2, = 0.35). A significant reduction in the number of playground injuries was seen in stage 1 (1 v. 62, < 0.001) and stage 2 (6 v. 35, < 0.001), and there was an increase in the number of self-propelled transit injuries (31 v. 10, = 0.002) during stage 1. In stage 3, all patient demographic characteristics and all characteristics of operatively treated injuries resumed their prepandemic distributions.
Provincial lockdown measures designed to limit the spread of SARS-CoV-2 significantly altered the volume and demographic characteristics of pediatric orthopedic injuries that required operative management. The findings from this study will serve to inform health system planning for future emergency lockdowns.
2020 年 3 月，安大略省实施封锁以减少 SARS-CoV-2 病毒的传播。学校、娱乐设施和非必要的企业都关闭了。在 6 个月的时间里（2020 年 3 月至 9 月），通过 3 个不同阶段放宽了限制。我们旨在确定 COVID-19 公共卫生封锁的每个阶段对儿科骨科创伤的流行病学的影响。
我们进行了一项回顾性队列研究，比较了大流行期间每个封锁阶段在一级儿科创伤中心就诊的急诊（ED）就诊和接受手术治疗的骨科损伤与 2019 年同期的病例量（大流行前）。进一步的分析基于患者的人口统计学特征、损伤严重程度、损伤机制和损伤的解剖部位。
与大流行前相比，ED 就诊减少了 20%（1356 例比 1698 例，<0.001），手术病例减少了 29%（262 例比 371 例，<0.001）。封锁阶段 1 的手术病例数每天减少 1.3 例（1.3 例比 2.0 例，<0.001），阶段 2 减少 1.7 例（1.7 例比 3.0 例，<0.001），但阶段 3 无明显差异（2.4 例比 2.2 例，=0.35）。在阶段 1（1 例比 62 例，<0.001）和阶段 2（6 例比 35 例，<0.001），游乐场受伤的数量显著减少，而在阶段 1，自行推进的交通伤害数量增加（31 例比 10 例，=0.002）。在第 3 阶段，所有患者的人口统计学特征和所有接受手术治疗的损伤特征都恢复到大流行前的分布。
旨在限制 SARS-CoV-2 传播的省级封锁措施显著改变了需要手术治疗的儿科骨科损伤的数量和人口统计学特征。本研究的结果将为未来紧急封锁的卫生系统规划提供信息。
