Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the “golden weeks”

Figures & data

Table 1. Results from the acute referrals and requirement for surgery between both time intervals pre-COVID 2019 and COVID 2020. Values are n (%) unless otherwise specified

	Pre-COVID	COVID
	N = 302	N = 97	p-value
Demographic
Male	183 (61)	53 (55)	0.3
Female	119 (39)	44 (45)
Median age (MAD)	10 (3)	7 (4)	0.02
Median ASA (MAD)	1 (0)	1 (0)	0.8
Injury
Upper limb	201 (67)	67 (69)
Lower limb	89 (29)	23 (24)
Pelvis	3 (1)	1 (1)
Infection	6 (2)	6 (6)
Other	3 (1)	0 (0)
Mechanism of injury
Sporting	114 (38)	20 (21)	0.002
Fall	141 (47)	50 (52)
Fall from height >1.5m	8 (3)	6 (6)
Road traffic accidents	4 (1)	2 (2)
Pathological	0 (0)	2 (2)
Other	21 (7)	8 (8)
Laceration	0 (0)	1 (1)
Infection	6 (2)	4 (4)
Trampoline	5 (2)	3 (3)
N/A	0 (0)	1 (1)
Open injury	4 (1)	4 (4)
Trauma call	3 (1)	1 (1)
Admission	33 (11)	18 (19)
Operative management	48 (16)	16 (16)
Safeguarding	25 (8)	11 (11)
Comorbidity
ADHD	0 (0)	1 (1)
Asthma	7 (2)	3 (3)
Osteogenesis imperfecta	1 (0)	1 (1)
None	276 (91)	90 (93)
Autism	2 (1)	1 (1)
Eczema	1 (0)	1 (1)
Leukaemia	1 (0)	0 (0)
Epilepsy	2 (1)	0 (0)
G6PD deficiency	1 (0)	0 (0)
Sickle cell	1 (0)	0 (0)
Type 1 diabetes mellitus	3 (1)	0 (0)
Tuberculosis	1 (0)	0 (0)
WPW syndrome	1 (0)	0 (0)
Febrile convulsions	2 (1)	0 (0)
Migraine	1 (0)	0 (0)
Thalassaemia	1 (0)	0 (0)
COVID status
Negative		1 (1)
Positive		2 (2)
Not tested		94 (97)
Clinic outcome
Discharge	164 (54)	59 (61)
Referral	2 (1)	2 (2)
N/A	103 (34)	9 (9)
Follow-up	23 (8)	22 (23)	0.001
DNA	10 (3)	5 (5)
Clinic pathway
Hybrid – face to face
+ virtual clinics	0 (0)	4 (4)
Discharged from face
to face clinic	2 (1)	2 (2)
Discharged via virtual clinic	0 (0)	26 (27)	< 0.001
Face to face clinic	290 (96)	47 (48)	< 0.001
N/A	9 (3)	10 (10)
Referral to virtual clinic	0 (0)	9 (9)	< 0.001
Referral to hand therapy	1 (0)	0 (0)
Number of follow-ups to date	2	1	< 0.001
Days to discharge	0	0	0.7
Days to first orthopaedic review	7	0	< 0.001

Table 2. Risk, prevalence and odds ratios and (95% CI) between post- versus pre-COVID era

Factor	RR or PR (CI)	OR (CI)	p-value ^a
Sporting related injury	0.55 (0.36–0.83)	0.43 (0.25–0.74)	0.002
Follow-up	3.1 (1.8–5.3)	3.6 (1.9–6.7)	< 0.001
Clinic pathway			< 0.001
Face to face consultation	0.55 (0.41–0.62)	0.05 (0.02–0.08)
Virtual fracture clinic	59 (3.5–1,000)	65 (3.7–1,127)
Discharge from virtual fracture clinic	164 (10–2,664)	224 (14–3,723)

^aFisher’s exact test