Has COVID-19 affected the number and severity of visits to a traumatology emergency department?

AIMS: To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity. METHODS: Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years. RESULTS: The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%. CONCLUSION: A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones.Cite this article: Bone Joint Open 2020;1-10:617-620.

Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic. METHODS: This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected. RESULTS: In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers. CONCLUSIONS: There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[Level of stress and coping strategy in medical students compared with students of other careers]. / Niveles de estrés y formas de afrontamiento en estudiantes de Medicina en comparación con estudiantes de otras escuelas.

OBJECTIVE: To assess the levels of stress and the coping strategies in students of the faculties of Medicine, Law and Psychology at a private university in Lima. MATERIALS AND METHODS: Cross-sectional analytic and comparative study involving three university careers. For data collection, the SISCO inventory for academic stress and the questionnaire of stress coping (CAE) were used. For inferential analysis, Spearman's rank correlation coefficient, Kruskall Wallis and Dunn Test (multiple comparison post hoc) were used. RESULTS: The average age was 19.5±2.5 years. Of them, 33.9% were students from the Medical faculty and 92.4% were worried or nervous (stress manifestations). The students from the Medical faculty had the highest level of stress (median, 46.7) compared to the students from the Psychology faculty (median, 39.1) and the students from the Law faculty (median, 40.2) (p<0.05). The most common coping strategies were focusing on the problem, positive re-evaluation, and social support. The least used strategy was religion. CONCLUSION: The Medical faculty students show the highest level of stress. Coping strategies in the three groups are focusing on the problem, positive re-evaluation, and social support. The least used strategy was religion.