How COVID-19 has affected emergent visits to a Latin-American trauma department: Experience at a Peruvian national trauma referral center

• Published in: Injury 2020-12, Vol.51 (12), p.2834-2839
• Main Authors: Pintado, Juan F., Gibaja, William, Vallejos, Rodrigo A., Rosas, William, Guerra-Farfan, Ernesto, Nuñez, Jorge H.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Comorbidity; Coronavirus; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 - virology; Emergency; Emergency Service, Hospital - statistics & numerical data; Female; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Pandemic; Pandemics - prevention & control; Patient Acceptance of Health Care - statistics & numerical data; Patient Admission - statistics & numerical data; Peru - epidemiology; Referral and Consultation - statistics & numerical data; SARS-CoV-2 - isolation & purification; Tertiary Care Centers - statistics & numerical data; Trauma; Trauma Centers - statistics & numerical data; Wounds and Injuries - diagnosis; Wounds and Injuries - epidemiology; Wounds and Injuries - therapy
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.11.005

•As in other countries health problems such as osteoporotic hip fractures may in fact remain stable during the implementation of stringent lock-down measures for the population.•Like osteoporotic hip fractures, diabetic foot ulcers are usually manifested in elderly, non-working people, whose risk of injury thereby should not have been impacted by staying home from work.•In our study, the four most common indications for our surgery service admission during the state of emergency declaration were osteoporotic hip fracture, ankle fracture, diabetic foot and forearm fracture. By May 2020, Peru was the country with the third most COVID-19 cases in the Americas. The current study's overall aim was to examine the impact of the current COVID-19 outbreak on the number of non-COVID-related patient presentations to a major national emergency traumatology/orthopedics referral center in Latin America. An observational study was performed at one of Peru's main tertiary trauma referral centers, during the current COVID-19 pandemic. Numbers of non-follow-up patients presenting to the traumatology/ orthopedics service were counted and compared between January through April 2019 and January through April 2020; and between the month immediately prior to the Peruvian government's implementation of national lock-down measures (Feb 16—Mar 15; Period 1) and the month immediately following (Mar 16—Apr 15; Period 2). The number of surgery service hospitalizations also was compared pre- versus post lockdown initiation (Period 1 vs. 2), as were patient characteristics and outcomes, like age, sex, discharge disposition, mortality, indications for hospital admission, and COVID-19 status. Comparing 2019 and 2020, no appreciable differences were detected in the number of patients seen in either January or February. However, relative to March and April 2019, the numbers of patients seen in March and April 2020 (the two months after the first Peruvian case of COVID-19 was detected) were reduced by 55.8 and 88.6%, respectively. Comparing the months immediately pre and post lockdown, the number of service patients declined by 79.9% in April, while the number of hospitalizations declined by 30.9%. The number of admissions for various surgical indications either remained stable or declined in parallel with the overall decline in admissions for all indications except for osteoporotic hip fractures and diabetic foot ulcers (both of which increased proportional to the overall number of admissio