Impact of the first wave of COVID-19 on stroke admissions across three tertiary hospitals in Brisbane.

BACKGROUND: COVID-19 has caused a global shift in healthcare-seeking behaviour; however, presentation rates with serious conditions, such as stroke in low COVID-19-prevalence cities, has received less attention. AIMS: To determine if there was a significant reduction in stroke admissions, delivery of acute reperfusion therapies, or increased delays to presentation during the first wave of the COVID-19 pandemic. METHODS: A multicentre, retrospective, observational cohort study was performed across three tertiary hospitals in Brisbane, Australia. Cases were identified using ICD-10 codes and then individually reviewed for eligibility using prespecified inclusion and exclusion criteria. All metrics were compared over 3 months from 1 March to 31 May 2020 with two corresponding 3-month periods in 2018 and 2019. RESULTS: There was a mean of 2.15 (95% CI 1.87-2.48) stroke admissions per day in the examined pandemic months compared with 2.13 (95% CI 1.85-2.45) and 2.26 (95% CI 1.97-2.59) in March to May 2018 and 2019 respectively, with no significant difference found (P = 0.81). There was also no difference in rates of intravenous thrombolysis (P = 0.82), endovascular thrombectomy (P = 0.93) and time from last known well to presentation (P = 0.54). Conversely, daily emergency department presentations (including non-stroke presentations) significantly reduced (P < 0.0001). CONCLUSIONS: During the early months of the COVID-19 pandemic there was no significant reduction in stroke presentations, use of acute reperfusion therapies or delays to presentation, despite a reduction in ED presentations for any cause. Our results differ from the global experience, with possible explanations, including differences in public health messaging and healthcare infrastructure.

Impact of COVID-19-related social restrictions on orthopaedic trauma in a level 1 trauma centre in Sydney: the first wave.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected communities worldwide. This study examines the impact that public health measures to control viral spread have had on orthopaedic trauma presenting to an Australian level 1 trauma centre. We hypothesized that the volume of orthopaedic trauma in the period of social distancing would decrease, and the mechanisms of injury differ, compared to pre-pandemic times. METHODS: We performed a retrospective analysis of patients requiring emergency orthopaedic surgery between 16 March and 21 April 2020 (the period after social distancing and lockdown commenced), and compared it to the group of patients from the same period in 2019. We collected demographic data, as well as injury type, anatomical location, mechanism of injury and surgical logistics. RESULTS: During the COVID-19 period, total emergency operations performed decreased by 15.6% compared to the same period in 2019. Orthopaedic admissions decreased by 30.8%. Demographics of the groups were unchanged. Anaesthetic time decreased, but total time spent in the operating theatre was unchanged. Road trauma comprised a similar proportion of cases overall; however, cycling-related accidents increased significantly, making up 11% of presentations during COVID-19. Sporting injuries, work-related injuries and multi-traumas reduced during the pandemic. CONCLUSION: The impact of COVID-19-related lockdown measures and social distancing on orthopaedic trauma in Australia has been an overall decrease in volume of cases, combined with significant changes in the mechanisms of injury necessitating surgery.