The Effect of Nationwide Lockdown in India on the Epidemiology of Injuries During the First Wave of COVID-19

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Background. The pattern of hospital admissions and medical care changed during the COVID pandemic.

The aim of the study — to describe the nature of patients attending the orthopedic emergency department of a level 1 trauma center in terms of number and proportion based on demographic characteristics and the nature of the injury before the lockdown, during the lockdown, and during the unlocking period of the nationwide lockdown for controlling the COVID-19 pandemic in India.

Methods. We conducted a longitudinal study from 01.01.2020 to 31.12.2020. Patients attending the orthopedic emergency were grouped based on cause, type, and site of injury. The median number observed each day with IQR. The distribution of the same was compared between the prelockdown with lockdown period and the lockdown period with a phased unlocking period.

Results. A total of 10513 patients were included. There was a statistically significant reduction in the proportion of patients needing inpatient care between the prelockdown phase and lockdown phase (p = 0.008). However, this was not seen between lockdown and postlockdown periods (p = 0.47). The proportion of road traffic accidents dropped from 26% to 15% during this time (p<0.001). The proportion of contusions was reduced and that of soft tissue injuries increased (p<0.001). The proportion of lower limb injuries decreased from the prelockdown phase to the lockdown phase, and that of spinal injury patients increased (p = 0.007). The proportion of patients with contusions increased and soft tissue injuries decreased during this period (p<0.001). Lower limb injuries and road traffic accidents increased, and spinal injuries were reduced (p<0.001).

Conclusion. The lockdown for controlling the spread of the pandemic affected the demographic and epidemiological aspects of injuries attending the orthopedic emergency department of a level 1 trauma center in a developing country. There was a decrease in the proportion of females and children attending the ED during the lockdown. The number of road traffic accedents s decreased during the lockdown. The number of patients with contusions attending the trauma center during the lockdown decreased, but there was an increase in the number of patients with spine injuries. We suggest that improvement in triage facilities, wider use of telemedicine, and increasing the stock of PPEs are essential for tackling such situations in the future.

作者简介

Balaji Zacharia

Government Medical College

编辑信件的主要联系方式.
Email: balaji.zacharia@gmail.com
ORCID iD: 0000-0001-5080-1656

Professor

印度, Kozhikode, Kerala, 673008

Harshitha Hayavadana Udupa

Government Medical College

Email: harshithaudupa@gmail.com
ORCID iD: 0000-0002-9746-8528

Senior Resident

印度, Kozhikode, Kerala, 673008

Rahul Chandran

Government Medical College

Email: rahulchandrannair55@gmail.com
ORCID iD: 0000-0002-4897-5582

Senior Resident, Dept. Of Orthopedics

印度, Kozhikode, Kerala, 673008

Arun Prakas

Government Medical College

Email: drarunprakas@gmail.com
ORCID iD: 0009-0007-5173-2569

Assistant Professor, Department of Orthopedics

印度, Kozhikode, Kerala, 673008

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2. Fig. 1. Line chart of the total number of patients presented each day with a 7-day moving average

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3. Fig. 2. Component area chart of a 7-day moving average of males and females presenting to casualty each day

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4. Fig. 3. Component area chart of the proportion of the 7-day moving average of the number of patients of different age groups presenting to casualty each day

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5. Fig. 4. Component area chart of the 7-day moving average of the proportion of patients needing OP/IP care each day

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6. Fig. 5. Component area chart of the 7-day moving average of the proportion of different causes of injuries encountered each day

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7. Fig. 6. Component area chart of the 7-day moving average of the proportion of different sites of injuries encountered each day

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8. Fig. 7. The association of the total number of outpatients and inpatients during the first wave of the pandemic with the total number of COVID-19 patients in a day in our district and different phases of lockdown in our country. The red line chart is the new COVID cases reported in a day in our district. blackline — total patients, orange — outpatients, blue — inpatients. vertical lines — red — lockdown phases, green — unlock phases

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