Impact of screening COVID-19 on orthopedic trauma patients at the emergency department: A consecutive series from a level I trauma center. Issue 4 (31st March 2021)

• Record Type: Journal Article
• Authors: Ma, Hsuan-Hsiao; Tsai, Shang-Wen; Chen, Cheng-Fong; Wu, Po-Kuei; Chen, Chao-Ming; Chiang, Chao-Ching; Chen, Wei-Ming
• Is Part Of: Journal of the Chinese Medical Association. Volume 84:Issue 4(2021)
• Page Start: 423
• Page End: 427
• Publication Date: 2021-03-31
• Subjects: Coronavirus -- COVID-19 -- Emergency service -- hospital -- Fever -- Taiwan -- Trauma; Medicine -- Periodicals; 610.5
• DOI: 10.1097/JCMA.0000000000000503
• Languages: English
• ISSNs: 1726-4901

Abstract

Abstract : Background: Coronavirus disease 2019 (COVID-19) posed a major threat to the clinical practice of orthopedic surgeons, especially in the emergency department. We aim to present: (1) the criteria established by the Surgery Management Committee of Taipei Veterans General Hospital in response to COVID-19 and (2) the impact of COVID-19 screening on orthopedic trauma patients in the emergency department. Methods: From April 1 to April 30, 2020, all orthopedic trauma patients in the emergency department were screened for COVID-19 if they fulfilled any of the following: (1) travel from abroad within 14 days, (2) high-risk occupation, (3) contact or cluster history with a COVID-19–positive patient, and (4) any associated symptom, including fever up to 38°C, cough, sore throat, rhinorrhea, loss of taste or smell, muscle soreness, malaise, or shortness of breath. We recorded details on the injury, fever, management, and associated outcomes. Results: Of the 163 orthopedic trauma patients presenting to the emergency department, 24 were screened for COVID-19; of these, 22 received surgery. Sixty-two patients received surgery without screening for COVID-19. Fever was the most common reason to screen for COVID-19 (N = 20; 83.3%). No patients were COVID-19 positive. Screened patients had a significantly longer mean interval from presentation to the emergency department to surgery (2.7 ± 2.5 vs. 1.5 ± 0.8 days, p = 0.037). Of the 20 patients screened because of fever, the focus was not identified in 12 (60.0%) patients. The other eight had urinary tract infection (N = 6; 27.2%), septic hip (N = 1; 4.6%), and concomitant pneumonia and urinary tract infection (N = 1; 4.6%). The mean duration of fever and hospital stay was 4.3 ± 4.6 and 8.7 ± 4.9 days, respectively. There were no thromboembolic events, surgical complications, or in-hospital mortality. Conclusion: We developed safe and reliable screening criteria for this COVID-19 pandemic. The delay in surgery was reasonable and did not adversely affect in-patient outcomes.