Changes in Emergency Department Volumes at the Largest U.S. Military Hospital During the COVID-19 Pandemic.

INTRODUCTION: The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD's largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic. MATERIALS AND METHODS: We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020). RESULTS: Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all). CONCLUSIONS: The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.

Abstracts Accepted for Presentation at Orthopaedic Trauma or Arthroplasty Conferences: Which Conference Is the Best Indicator of Future Publication?

Time and financial resources pose limitations to orthopaedic surgeons wishing to advance their orthopaedic knowledge, and surgeons frequently must choose one meeting to attend. We sought to determine whether abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting or the trauma (Orthopaedic Trauma Association [OTA]) or arthroplasty (American Association of Hip and Knee Surgeons [AAHKS]) subspecialty meetings, respectively, were higher yield with respect to material ultimately being published. We hypothesized that papers accepted by AAOS would demonstrate higher conversion to publication compared with OTA and AAHKS but expected abstract publication rates from OTA and AAHKS to be similar. METHODS: All clinical and preclinical abstracts from the trauma and total joint arthroplasty subspecialties presented at the AAOS, OTA, and AAHKS annual meetings in 2015 were evaluated. Data collected included the current status of the publication, journal and publication date, time to publication, and country of origin (United States or international). RESULTS: There were 516 (N = 213, AAOS; N = 303, OTA) trauma and 711 (N = 470, AAOS; N = 241 AAHKS) arthroplasty poster and podium presentations. When comparing publication rates in trauma, no significant difference was observed in overall publication rates between AAOS and OTA at 57.2% (N = 122 published) and 60.4% (N = 183 published), respectively (P = 0.54). In addition, no significant difference was observed in overall publication rates in arthroplasty between AAOS and AAHKS, with publication rates of 65.3% (N = 307 published) and 59.8% (N = 144 published), respectively (P = 0.17). Of abstracts that were published, AAHKS arthroplasty abstracts were more likely to be published in The Journal of Arthroplasty (JOA, 69.4%) compared with OTA trauma abstracts published in the Journal of Orthopaedic Trauma (JOT, 33.3%), P < 0.001. CONCLUSION: The overall publication rates, along with publication rates to premiere subspecialty journals, is indicative of forefront research being presented at the three annual meetings. Given the comparable research quality of OTA and AAHKS abstracts, the AAOS meeting appears to provide the highest yield for surgeons with more generalized practices or practices spanning multiple subspecialties.

Bradford's law: identification of the core journals for neurosurgery and its subspecialties.

OBJECTIVE: Bradford's law describes the scatter of citations for a given subject or field. It can be used to identify the most highly cited journals for a field or subject. The objective of this study was to use currently accepted formulations of Bradford's law to identify core journals of neurosurgery and neurosurgical subspecialties. METHODS: All original research publications from 2009 to 2013 were analyzed for the top 25 North American academic neurosurgeons from each subspecialty. The top 25 were chosen from a ranked career h-index list identified from previous studies. Egghe's formulation and the verbal formulation of Bradford's law were applied to create specific citation density zones and identify the core journals for each subspecialty. The databases were then combined to identify the core journals for all of academic neurosurgery. RESULTS: Using Bradford's verbal law with 4 zone models, the authors were able to identify the core journals of neurosurgery and its subspecialties. The journals found in the most highly cited first zone are presented here as the core journals. For neurosurgery as a whole, the core included the following journals: Journal of Neurosurgery, Neurosurgery, Spine, Stroke, Neurology, American Journal of Neuroradiology, International Journal of Radiation Oncology Biology Physics, and New England Journal of Medicine. The core journals for each subspecialty are presented in the manuscript. CONCLUSIONS: Bradford's law can be used to identify the core journals of neurosurgery and its subspecialties. The core journals vary for each neurosurgical subspecialty, but Journal of Neurosurgery and Neurosurgery are among the core journals for each neurosurgical subspecialty.