A Comparative Multicenter Study on the Epidemiology of Traumatic Fractures during the Coronavirus Disease 2019 Early Emergency Response Period in Yogyakarta Special Region, Indonesia

Luthfi Hidayat; Bernadeta Fuad Paramita Rahayu; Rosyad Nur  Khadafi; Acep Eko Budi  Purwanta; Marda Ade  Saputra; Eko Sumardiyono; Aditya Fuad Robby  Triangga

doi:10.3889/oamjms.2021.6043

Authors

Luthfi Hidayat Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0002-3496-5906
Bernadeta Fuad Paramita Rahayu Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0001-5124-9437
Rosyad Nur Khadafi Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0003-4760-2220
Acep Eko Budi Purwanta Department of Orthopaedics and Traumatology, Wates Regional Public Hospital, Yogyakarta, Indonesia https://orcid.org/0000-0001-7984-4836
Marda Ade Saputra Department of Orthopaedics and Traumatology, Yogyakarta Regional Public Hospital, Yogyakarta, Indonesia https://orcid.org/0000-0002-5874-3697
Eko Sumardiyono Department of Orthopaedics and Traumatology, Wonosari Regional Public Hospital, Yogyakarta, Indonesia
Aditya Fuad Robby Triangga Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.6043

Keywords:

Coronavirus disease 2019, Epidemiology, Trauma, Fracture, Indonesia

Abstract

BACKGROUND: The changes of lifestyle and mobility during the coronavirus disease 2019 (COVID-19) pandemic may influence the epidemiology of traumatic fractures.

AIM: This study aimed to investigate the epidemiology of traumatic fractures in Yogyakarta Special Region (Daerah Istimewa Yogyakarta [DIY]) during the COVID-19 emergency response period and compare the data with the similar period in the previous year.

METHODS: This was a retrospective study involving five secondary referral hospitals and one tertiary referral hospital. We included all patients who presented to the emergency departments or orthopedic clinics who were then diagnosed with new-onset fractures. We compared the data during the emergency response period (COVID group) with a similar period in 2019 (control group).

RESULTS: There were 1249 patients with 1428 fractures included in this study. There was 47.68% reduction of patients during the emergency response period. There was no significant difference in proportion of gender and mean of age (control group vs. COVID group: 55.9% vs. 54.8%, p = 0.717 for male gender; 42.64 ± 24.03 years vs. 42.20 ± 23.34 years, p = 0.886 for mean of patients’ age). There were significant increases in the proportions of patients experiencing low-energy injuries (38.0% vs. 30.8%, p = 0.012), injuries occurring at home (34.0% vs. 23.8%, p = 0.001), and surgically treated closed fractures (51.8% vs. 45.3%, p = 0.038), along with decrease of patients’ referrals (1.6% vs. 4.1%, p = 0.018) during the pandemic. The difference in proportions of fracture type, osteoporotic fractures, and multiple trauma was not significant (control group vs. COVID group: 19.2% vs. 17.4%, p = 0.418 for open fracture; 15.4% vs. 14.7%, p = 0.750 for osteoporotic fracture; and 9.0% vs. 7.0%; p = 0.217 for multiple trauma).

CONCLUSIONS: During the COVID-19 emergency response period in DIY, there were nearly half reduction of patients with fractures, increased proportion of patients injured at home, reduced proportion of patients referred to another hospital, and increased proportion of surgically treated closed fractures. The knowledge about this epidemiological trend may help in developing preventive programs and treatment policy for fractures and other injuries during the current pandemic.

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References

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.

World Health Organization. WHO Director-General’s Remarks at the Media Briefing on 2019-nCoV on 11 February. Geneva: World Health Organization; 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-remarksat-the-media-briefing-on-2019-ncov-on-11-february-2020. [Last accessed on 2020 Jul 06]. https://doi.org/10.1093/ww/9780199540884.013.u44226

World Health Organization. WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19 11 March. Geneva: World Health Organization; 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-openingremarks-at-the-media-briefing-on-covid-19---11-march-2020. [Last accessed on 2020 Jul 06]. https://doi.org/10.1093/ww/9780199540884.013.u23682

Manusubroto W, Wicaksono AS, Tamba DA, Sudiharto P, Pramusinto H, Hartanto RA, et al. Neurosurgery services in Dr. Sardjito General Hospital, Yogyakarta, Indonesia, During the COVID-19 Pandemic: Experience from a developing country. World Neurosurg. 2020;140:e360-6. https://doi.org/10.1016/j.wneu.2020.05.124 PMid:32442732

Pemerintah Daerah DIY: Keputusan Gubernur Daerah Istimewa Yogyakarta Nomor 65/KEP/2020 Tentang Penetapan Status Tanggap Darurat Bencana Corona Virus Disease 2019 (COVID-19) di Daerah Istimewa Yogyakarta. In: Dokumen Publik Perkembangan COVID-19. Official website Pemerintah Daerah DIY; 2020. Available from: https://www.corona.jogjaprov.go.id/files/33/Covid19/8/KepGub-DIY-No-65-KEP-2020-ttg-Penetapan-Status-Tanggap-Darurat-Bencana-COVID-19-di-DIY.pdf. [Last accessed on 2020 Jul 07]. https://doi.org/10.31334/trans.v9i1.87

Pemerintah Daerah DIY: Surat Edaran Nomor 1/SE/III/2020 Tentang Pelaksanaan Status Tanggap Darurat Bencana Corona Virus Disease (COVID-19) di Daerah Istimewa Yogyakarta. In: Dokumen Publik Perkembangan COVID-19. Official website Pemerintah Daerah DIY; 2020. Available from: https://www.corona.jogjaprov.go.id/files/33/Covid19/11/SE-Gubernurtentang-Status-Tanggap-darurat-Bencana-Covid-19-di-DIY.pdf. [Last accessed on 2020 Jul 07]. https://doi.org/10.31334/trans.v9i1.87

Djalante R, Lassa J, Setiamarga D, Sudjatma A, Indrawan M, Haryanto B, et al. Review and analysis of current responses to COVID-19 in Indonesia: period of January to March 2020. Prog Disaster Sci. 2020;2020:100091. https://doi.org/10.1016/j.pdisas.2020.100091

Herdiana D. Social distancing: Indonesian policy response to the corona virus disease 2019 (COVID-19). J Ilmu Adm Med Pengemb Ilmu Prakt Adm. 2020;17(1):93-110. https://doi.org/10.31113/jia.v17i1.555

Lv H, Zhang Q, Yin Y, Zhu Y, Wang J, Hou Z, et al. Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective and comparative multi-center study. Injury. 2020;51(8):1698-704. https://doi.org/10.1016/j.injury.2020.06.022 PMid:32563519

Luceri F, Morelli I, Accetta R, Mangiavini L, Maffulli N, Peretti GM. Italy and COVID-19: The changing patient flow in an orthopedic trauma center emergency department. J Orthop Surg Res. 2020;15(1):323. https://doi.org/10.1186/s13018-020-01816-1 PMid:32795347

Hernigou J, Morel X, Callewier A, Bath O, Hernigou P. Staying home during “COVID-19” decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the “tsunami of recommendations” could not lockdown twelve elective operations. Int Orthop. 2020;44(8):1473-80. https://doi.org/10.1007/s00264-020-04619-5 PMid:32451655

Park C, Sugand K, Nathwani D, Bhattacharya R, Sarraf KM. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: The “golden month.” Acta Orthop. 2020;91(5):556-61. https://doi.org/10.1080/17453674.2020.1783621 PMid:32573331

Dolci A, Marongiu G, Leinardi L, Lombardo M, Dess G, Capone A. The epidemiology of fractures and musculo-skeletal traumas during COVID-19 lockdown: A detailed survey of 17,591 patients in a wide Italian metropolitan area. Geriatr Orthop Surg Rehabil. 2020;11:215145932097267. https://doi.org/10.1177/2151459320972673 PMid:33240557

Turgut A, Arli H, Altundag U, Hancioglu S, Egeli E, Kalenderer O. Effect of COVID-19 pandemic on the fracture demographics: data from a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2020;54(4):355-63. PMid:32812872

Nu ez JH, Sallent A, Lakhani K, Guerra-Farfan E, Vidal N, Ekhtiari S, et al. Impact of the COVID-19 pandemic on an emergency traumatology service: experience at a tertiary trauma centre in Spain. Injury. 2020;51(7):1414-8. https://doi.org/10.1016/j.injury.2020.05.016 PMid:32405089

Hashmi PM, Zahid M, Ali A, Naqi H, Pidani AS, Hashmi AP, et al. Change in the spectrum of orthopedic trauma: Effects of COVID-19 pandemic in a developing nation during the upsurge: A cross-sectional study. Ann Med Surg. 2020;60:504-8. https://doi.org/10.1016/j.amsu.2020.11.044 PMid:33235717

Basaga a X, Pedersen M, Barrera-G mez J, Gehring U, Giorgis-Allemand L, Hoek G, et al. Analysis of multicentre epidemiological studies: Contrasting fixed or random effects modelling and meta-analysis. Int J Epidemiol. 2018;47(4):1343-54. https://doi.org/10.1093/ije/dyaa248 PMid:29939274

Nugraha HK, Adiantono A. Epidemiology of fractures and dislocations in children. Folia Med Indones. 2017;53(1):81-5. https://doi.org/10.20473/fmi.v53i1.5494

Susilo B, Priambodo A. Vertebral fracture characteristics at Dr. Kariadi hospital, Semarang. J Orthop Traumatol Indones. 2020;3(1):2-7.

Wijaya RK, Mustari MN. Evaluation of fracture on children in orthopaedic and traumatology division in Dr. Wahidin Sudirohusodo Central General Hospital Makassar January 2016-December 2017. Intisari Sains Medis. 2020;11(1):132-6. https://doi.org/10.15562/ism.v11i1.563

Campion JM, Maricic MJ. Osteoporosis in men. Am Fam Physician. 2003;67(7):1521-6. PMid:12722852

Yoo JH, Moon SH, Ha YC, Lee DY, Gong HS, Park SY, et al. Osteoporotic fracture: 2015 position statement of the Korean society for bone and mineral research. J Bone Metab. 2015;22(4):175. https://doi.org/10.11005/jbm.2015.22.4.175 PMid:26713308

Butcher N, Balogh ZJ. The definition of polytrauma: The need for international consensus. Injury. 2009;40(Suppl 4):S12-22. https://doi.org/10.1016/j.injury.2009.10.032 PMid:19895948

Osama T, Pankhania B, Majeed A. Protecting older people from COVID-19: Should the United Kingdom start at age 6? J R Soc Med. 2020;113(5):169-70. https://doi.org/10.1177/0141076820921107 PMid:32315559

Tarantino U, Cariati I, Tancredi V, Casamassima D, Piccirilli E, Iundusi R, et al. State of fragility fractures management during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17:7732. https://doi.org/10.3390/ijerph17217732 PMid:33105834

Josephson KR, Fabacher DA, Rubenstein LZ. Home safety and fall prevention. Clin Geriatr Med. 1991;7(4):707-32. PMid:1760790

Ren X. Pandemic and lockdown: A territorial approach to COVID-19 in China, Italy and the United States. Eurasian Geogr Econ. 2020;61(4-5):423-34. https://doi.org/10.1080/15387216.2020.1762103

Wicaksono RMTAD. Examining the Policies and Priorities of the Indonesian Government in Response to COVID-19. Pusat Penelitian Politik Lembaga Ilmu Pengetahuan Indonesia; 2020. Available from: http://www.politik.lipi.go.id/kolom/kolom-2/politik-nasional/1410-examining-the-policies-and-prioritiesof-the-indonesian-government-in-response-to-covid-19. [Last accessed on 2020 Dec 26]. https://doi.org/10.30556/jtmb.vol16.no1.2020.1064

Feichtinger X, Kocijan R, Mittermayr R, Baierl A, Schanda J, Wakolbinger R, et al. Fracture patterns in patients with multiple fractures: The probability of multiple fractures and the most frequently associated regions. Eur J Trauma Emerg Surg. 2020;46(5):1151-8. https://doi.org/10.1007/s00068-019-01087-4 PMid:30747275

Reihani H, Pirazghandi H, Bolvardi E, Ebrahimi M, Pishbin E, Ahmadi K, et al. Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran. Chin J Traumatol. 2017;202:75-80. https://doi.org/10.1016/j.cjtee.2016.02.004 PMid:28363517

Zalavras CG, Patzakis MJ. Open fractures: Evaluation and management. J Am Acad Orthop Surg. 2003;11(3):212-9. PMid:12828451