Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients.
Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients.
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DOI：
10.1136/bmjopen-2021-058526
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发表时间：
2022-05-06
期刊：
影响因子：
2.9
通讯作者：
Ollivere, Benjamin J.
中科院分区：
文献类型：
--
作者：
Ikram, Adeel;Norrish, Alan;Ollivere, Luke;Nightingale, Jessica;Valdes, Ana;Ollivere, Benjamin J.
在第一波 COVID-19 大流行期间，针对脆性骨折患者的既定护理途径和出院阈值发生了变化。这是为了增加医院床位容量并最大限度地降低住院患者感染 COVID-19 的风险。这项研究旨在确定第一波大流行期间该人群的超额死亡率。这是一项针对根据特定国际疾病分类 (ICD)-10 代码识别的脆性骨折患者的纵向队列研究。第一波大流行被定义为2020年3月1日至6月1日之间的3个月期间。对照组于2019年3月1日至6月1日期间出现在英格兰东米德兰地区的两家急性国家卫生服务医院。 1846名在上述两个指定匹配时间点发生脆性骨折的患者。所有脆性骨折患者的四个月死亡率以及对脆性髋部骨折患者的亚分析。大流行期间收治了 832 名脆性骨折患者（其中 104 人诊断为 COVID-19）。对照组有 1014 名出现脆性骨折的患者。经年龄和性别调整后，大流行期间入院的脆性骨折患者的死亡率 (14.7%) 显着高于大流行前队列 (10.2%) (HR=1.86; 95%CI 1.41 至 2.45; p<0.001)。大流行期间的住院时间较短（效应大小=−4.2 天；95% CI -5.8至–3.1，p<0.001）。对脆性髋部骨折患者的亚组分析显示，在大流行前队列中，死亡率为 8.4%，在大流行期间入院且未诊断出 COVID-19 的死亡率为 15.48%（HR=2.08；95% CI 1.11 至 3.90；p=0.021）。超额死亡人数显着增加，这不能用确诊的 COVID-19 感染来解释。大流行期间改变的护理途径和激进的出院标准可能是导致超额死亡人数增加的原因。
During the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity and minimise the inpatient risk of contracting COVID-19. This study aims to identify the excess death rate in this population during the first wave of the pandemic. A longitudinal cohort study of patients with fragility fractures identified by specific International Classification of Diseases (ICD)-10 codes. The first wave of the pandemic was defined as the 3-month period between 1 March and 1 June 2020. The control group presented between 1 March and 1 June 2019. Two acute National Health Service hospitals within the East Midlands region of England. 1846 patients with fragility fractures over the aforementioned two specified matched time points. Four-month mortality of all patients with fragility fractures with a subanalysis of patients with fragility hip fractures. 832 patients with fragility fracture were admitted during the pandemic period (104 diagnosed with COVID-19). 1014 patients presented with fragility fractures in the control group. Mortality in patients with fragility fracture without COVID-19 was significantly higher among pandemic period admissions (14.7%) than the pre-pandemic cohort (10.2%) (HR=1.86; 95% CI 1.41 to 2.45; p<0.001) adjusted for age and sex. Length of stay was shorter during the pandemic period (effect size=−4.2 days; 95% CI −5.8 to –3.1, p<0.001). Subanalysis of patients with fragility hip fracture revealed a mortality of 8.4% in the pre-pandemic cohort, and 15.48% during pandemic admissions with no COVID-19 diagnosis (HR=2.08; 95% CI 1.11 to 3.90; p=0.021). There is a significant increase in excess death, not explained by confirmed COVID-19 infections. Altered care pathways and aggressive discharge criteria during the pandemic are likely responsible for the increase in excess deaths.
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影响因子：
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作者：
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通讯作者：
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DOI：
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