Lessons learnt from COVID 19: An Italian multicentric epidemiological study of orthopaedic and trauma services.
Lessons learnt from COVID 19: An Italian multicentric epidemiological study of orthopaedic and trauma services.
复制标题
DOI：
10.1016/j.jcot.2020.05.021
复制
发表时间：
2020-07-01
影响因子：
--
通讯作者：
Scaglione, Michelangelo
中科院分区：
文献类型：
--
作者：
Giuntoli, Michele;Bonicoli, Enrico;Scaglione, Michelangelo
引言：由SARS-CoV-2引起的大流行给世界各地的大多数卫生系统带来了压力。许多医院不得不重新组织以应对紧急情况，因此非核心活动被暂停或取消，引起了管理问题。这项多中心研究的目的是报告COVID和前COVID时代之间的流行病学骨科和创伤学数据，并分析患者的需求及其管理方法：我们报告并比较了COVID（2020年3月）和前COVID（2019年3月）时代在托斯卡纳的三个主要医院中心进行的创伤学和择期骨科手术。我们还报告了主要中心骨科急救就诊次数的流行病学数据，分析了主要差异。我们报告了每家中心确诊COVID 19患者的数量、诊断、合并症、治疗、住院过程、并发症和结局。我们还指出了医务人员和患者在任何访视时使用的PPE类型。结果：所有中心的计划手术急剧减少，大部分手术都是在COVID期间进行的肿瘤，感染和植入物动员，延迟了所有其他手术。创伤活动在两个时间点之间略有下降：股骨近端骨折继续以与新冠肺炎前相同的数量参与我们的医院，而轻微创伤急剧下降。我们报告骨科急救减少了70. 95%，急救就诊/住院比在新冠肺炎前为13. 8，而在新冠肺炎期间为5. 8。共有5名确诊的新冠肺炎患者接受了骨折治疗，其中4人痊愈，无并发症。我们只报告一例新冠肺炎患者死亡。结论：COVID-19提出了许多重要问题，例如在大流行期间需要治疗常规疾病的患者的最佳管理。在大流行期间，病人从一个地区流向另一个地区，在同一地理区域内采取综合办法可能有助于更好地分配资源和管理病人的需要。我国采取的预防措施似乎有效，但这场COVID-19危机的首次经历凸显了我国卫生系统的长期问题，我们相信我们必须“吸取教训”，以便在未来做好更好的准备。
INTRODUCTION: The Pandemic caused by the SARS-CoV-2 has put a strain on the most of health systems all over the world. Many hospitals had to re-organize to deal with the emergency, so that the non-core activities have been suspended or cancelled, raising management problems. The aim of this multicentre study is to report the epidemiological orthopaedic and traumatological data between COVID and pre-COVID era and to analyse patients' needs and their management.METHODS: We reported and compared traumatological and elective orthopaedic surgeries performed in three of the main hospital centres in Tuscany during COVID (March 2020) and pre-COVID (March 2019) era. We also reported the epidemiological data about the number of orthopaedic first aid visits at the main hub, analysing the main differences. For each centre, we reported the number, diagnosis, co-morbidities, treatment, hospital course, complications and outcomes of confirmed COVID 19 patients. We also indicated what kind of PPE were used by medical staff and patients at any visit.RESULTS: The scheduled surgery drastically decreased in all the centres and the most of procedures were carried out for tumours, infections and implant mobilizations during the COVID time, delaying all the other ones. Trauma activities slightly decreased between the two time points: proximal femur fractures continued to engage our hospitals at the same pre-COVID volumes, while minor traumas drastically decreased. We report a decrease of 70.95% in orthopaedic first aid, with first-aid-visits/hospitalization ratio of 13.8 in the pre-COVID time vs 5.8 in the COVID time. A total of 5 confirmed COVID patients were treated for fractures and 4 of them healed without complications. We report just one case of death among COVID patients. All the medical staff members have worn the PPE and no one have developed COVID symptoms.CONCLUSIONS: The COVID-19 raised many important issues, such as the optimal management of patients requiring the treatment of conventional diseases during a pandemic. The flow of patients changes from one area to another during a pandemic and an integrated approach within the same geographical area could be useful to better allocate resources and manage the patients' needs. The preventive measures put in place in our country seem to work, but this first experience with COVID-19 crisis highlighted the chronic problems of our health system and we believe that we have to "learn the lesson" to be better prepared in the future.