ABSTRACT
A protocol for a retrospective cohort study and interrupted time series analysis to investigate the effect of successive COVID related "lockdown" restrictions on major trauma presentations and patient outcomes in English hospitals. The study specifically aims to assess: 1) The impact of successive "lockdowns" on the volume, demographics, injury mechanism, severity, treatment and outcomes of major trauma in England. 2) If the implementation of "lockdowns" affected major trauma related mortality. A patient cohort will be derived from the Trauma and Audit Research Network (TARN) database, for all trauma receiving hospitals in England, between 1st of January 2017 to 1st of September 2021. This period encompasses two national "lockdown" periods (23rd March 2020 to 29th June 2020 and 2nd Nov 2020 to 16th May 2021) in England. A time series will be used to illustrate changes in the volume and mechanism of injury associated with successive "lockdowns". Demographic characteristics and features of the clinical care pathways will be compared during the "lockdown" and equivalent pre-COVID periods. To specifically assess if there were any changes in risk adjusted mortality associated with the "lockdowns" interrupted time series analysis will be conducted.
ABSTRACT
BACKGROUND: This study investigated the completeness, accuracy, quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry - Ankle Arthrodesis pathway. METHODS: An observational study using retrospective data derived from the BOFAS registry. Adults aged ≥18 years with a record of undergoing ankle arthrodesis in the UK from 2014 to 31/10/2019 were included. Accuracy of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables. The pre and post treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) including MOXF-FQ scores for pain/walking/standing/social interaction; NRS pain; EQ-5D-5L; and EQ-5D-5L-Health VAS at baseline, 6 months, and 12 months. RESULTS: Mean age of the study population (n = 186) was 62.3 (±12.9) years and 65% of the study cohort were male. Completeness of data collection was disappointing but variables such as BMI (62.4%) smoking status (82.3%) were reasonably well recorded. PROMs scores were well recorded at baseline but rapidly declined at 6 and 12-months intervals. Reductions in MOXFQ and NRS pain scores by 12 months following surgery were statistically significant (p = 0.001 and p = 0.008), illustrating that most patients demonstrated reductions in pain intensity, improved walking/standing ability, and social interaction. CONCLUSION: These findings illustrate the potential effectiveness of surgery on all outcomes following ankle arthrodesis that merits evaluation in a clinical trial; but also demonstrated the difficulties in obtaining representative data sets. The analyses strongly suggest that with the improvements in data quality greater resources would bring, the BOFAS registry would become a valuable tool.
