The Impact of COVID-19 on the Emergency Presentation of Hand Injuries
Claudia Siniakowicz, B.S.1, Margaret Dalena, M.D.1, Kailash Kapadia, M.D.1, Jena Salem, B.A.1, Ankur Poddar, B.A.1 and Mark S. Granick, M.D.2, (1)Rutgers New Jersey Medical School, Newark, NJ, (2)Plastic Surgery Division, Rutgers New Jersey Medical School, Newark, NJ
Introduction: Hand injuries are dependent on seasonal changes in activities and risk factors. The unprecedented circumstances of the COVID-19 pandemic provided the framework to revisit this relationship. Public health measures limited hand-injury-causing activities, including heavy machinery accidents, fighting, and sports. Consequently, this study evaluates hand injury incidence and management during the pandemic.
Methods: A retrospective chart review was performed for patients presenting to the Emergency Department (ED) with hand injuries according to x-ray records. Two cohorts were analyzed. Pre-COVID-19 (PC) control patients presented to the ED between 03/21/2019 and 05/31/2019. During-COVID-19 (DC) patients presented to the ED during the lockdown from 03/21/2020 to 05/31/2020. All patients were treated at an urban, level 1 trauma hospital. The data set included non-identifiable demographics, etiology, concomitant injuries, management, and complications. Comparisons of these data points between PC and DC patients were statistically analyzed using binary, multinomial, and multiple linear regressions.
Results: 302 PC patients were identified, with 344 distinct hand injuries. 147 DC patients were identified, with 166 distinct hand injuries. A 51.3% reduction in ED presentations was observed from the PC to DC period. The average interval between injury and ED presentation was 1.93 days and 1.49 days in the PC and DC cohorts, respectively (p=0.316). DC patients were more likely to sustain injuries at home compared to PC patients (p<0.01). DC patients were more likely to sustain tool-related (p=0.014) and high-energy mechanism injuries (p<0.01). Open injuries, metacarpal fractures, and intra-articular fractures were more common in the DC cohort (p<0.05). There was no significant association in additional hand injuries sustained. Concomitant injuries, including long bone fractures, traumatic brain injury, spinal cord injury, and intrathoracic injuries were significantly more likely in DC patients (p<0.05). Soft tissue management was more likely to be conducted non-operatively in the DC cohort (p<0.05). In patients with only hand injuries, there was no significant difference in operative management: 22.5% and 25% in PC and DC patients, respectively. No significant difference in operative management was found between cohorts. DC patients were more likely to suffer nerve deficit complications (p=0.015). Otherwise, there was no significant difference in complications between cohorts.
Conclusions: The pandemic's effects on medical care are not yet fully explored. Despite medical limitations during the pandemic, changes in injury management observed between cohorts did not result in increased complications. This study demonstrated changes in hand injury patterns, management, and outcomes, elucidating the pandemic's impact on hand injuries.
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