The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study

BackgroundFirearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO.MethodsThis was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A “COVID” cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to “Historical” controls from an averaged period of corresponding dates in 2016–2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries.ResultsNine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001).ConclusionThe proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.     

The impact of the COVID-19 pandemic on cerebrovascular disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a systemic disease that affects nearly all organ systems through infection and subsequent dysregulation of the vascular endothelium. One of the most striking phenomena has been a coronavirus disease 2019 (COVID-19)–associated coagulopathy. Given these findings, questions naturally emerged about the prothrombotic impact of COVID-19 on cerebrovascular disease and whether ischemic stroke is a clinical feature specific to COVID-19 pathophysiology. Early reports from China and several sites in the northeastern United States seemed to confirm these suspicions. Since these initial reports, many cohort studies worldwide observed decreased rates of stroke since the start of the pandemic, raising concerns for a broader impact of the pandemic on stroke treatment. In this review, we provide a comprehensive assessment of how the pandemic has affected stroke presentation, epidemiology, treatment, and outcomes to better understand the impact of COVID-19 on cerebrovascular disease. Much evidence suggests that this decline in stroke admissions stems from the global response to the virus, which has made it more difficult for patients to get to the hospital once symptoms start. However, there does not appear to be a demonstrable impact on quality metrics once patients arrive at the hospital. Despite initial concerns, there is insufficient evidence to ascribe a causal relationship specific to the pathogenicity of SARS-CoV-2 on the cerebral vasculature. Nevertheless, when patients infected with SARS-CoV-2 present with stroke, their presentation is likely to be more severe, and they have a markedly higher rate of in-hospital mortality than patients with either acute ischemic stroke or COVID-19 alone.     

The impact of the COVID-19 pandemic on wellness among vascular surgeons

The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work–home life concerns.     

The impact of COVID-19 pandemic on vascular registries and clinical trials

Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.     

Increases in adolescent firearm injuries were associated with school closures during COVID-19

Background: Mitigation measures, including school closures, were enacted to protect the public during the COVID-19 pandemic. However, the negative effects of mitigation measures are not fully known. Adolescents are uniquely vulnerable to policy changes since many depend on schools for physical, mental, and/or nutritional support.  This study explores the statistical relationships between school closures and adolescent firearm injuries (AFI) during the pandemic.Methods: Data were drawn from a collaborative registry of 4 trauma centers in Atlanta, GA (2 adult and 2 pediatric). Firearm injuries affecting adolescents aged 11–21 years from 1/1/2016 to 6/30/2021 were evaluated. Local economic and COVID data were obtained from the Bureau of Labor Statistics and the Georgia Department of Health. Linear models of AFI were created based on COVID cases, school closure, unemployment, and wage changes.Results: There were 1,330 AFI at Atlanta trauma centers during the study period, 1,130 of whom resided in the 10 metro counties. A significant spike in injuries was observed during Spring 2020. A season-adjusted time series of AFI was found to be non- stationary (p = 0.60). After adjustment for unemployment, seasonal variation, wage changes, county baseline injury rate, and county-level COVID incidence, each additional day of unplanned school closure in Atlanta was associated with 0.69 (95% CI 0.34- 1.04, p < 0.001) additional AFIs across the city.Conclusion: AFI increased during the COVID pandemic. This rise in violence is statistically attributable in part to school closures after adjustment for COVID cases, unemployment, and seasonal variation. These findings reinforce the need to consider the direct implications on public health and adolescent safety when implementing public policy.     

Strategies in reconfiguration of hand injuries management during COVID-19 pandemic

During the COVID-19 pandemic there has been a re-organisation of care provided by the Trauma and Orthopaedic services in the United Kingdom. The National Health Service England (NHSE) speciality guide forms the primary responses to this pandemic, whilst British Society for the Surgery of Hand (BSSH) provides sub-specialty guidance on management of hand trauma. The orthopaedic community’s responsibility of providing a continuity of care for patients has to be balanced with measures to reduce risk of viral transmission (e.g. reduce face to face consultations) and also protect ion of both the patients and staff.We highlight the strategies applied whilst reconfiguration of hand injury management following publication of COVID-19 British Society for the Surgery of Hand and Indian Orthopaedic Association (IOA) guidelines.     

Adult kitchen-related burn injuries: The impact of COVID-19

IntroductionKitchen-related burn injuries are common and preventable. To limit the spread of COVID-19, public health orders encouraged the public to stay at home which may have led to an increase in kitchen-related burn injuries.ObjectiveTo assess adult kitchen-related burns treated in an outpatient setting in general, and especially looking at the impact of the COVID-19 pandemic on the incidence and epidemiology of these burns.MethodsFor this retrospective, population-based study, data were obtained for adult patients who suffered burn injuries resulting in a visit to a Canadian tertiary Burn Clinic between April 2016 and March 2021 specifically looking at demographics, burn etiology, severity and anatomical location and the need for surgery. Separately, we compared the patients before and after the beginning of the COVID-19 pandemic (April 1, 2020).ResultsA total of 1380 burn patients were identified. Of these, 38 % (N = 521) sustained a kitchen-related burn. The median patient age was 40 years (range 18–95) and 282 (54.1 %) were female. The most common etiology and location were scald (76.8 %) and anterior arm (28.5 %), respectively. Thirty-two (6.1 %) patients required admission to the Burn Unit and 26 of these had surgeries. Additionally, 72 (13.8 %) patients had surgery as an outpatient. During the COVID-19 pandemic, East Asian patients saw a significant increase in kitchen burns (p < 0.01).ConclusionOver 1/3 of burns at the outpatient burn clinic were kitchen-related. About 94 % of these were treated as outpatient only. The incidence of kitchen-related burns did not change during the COVID-19 pandemic, but we found significant differences in ethnic distribution. These results provide a unique opportunity to focus on communication and education and set up preventative measures.     

Surge in testicular torsion in pediatric patients during the COVID-19 pandemic

BackgroundTesticular torsion is a pediatric surgical emergency, and prompt diagnosis and treatment is imperative. During the COVID-19 pandemic, pediatric patients with symptoms of testicular torsion may be reluctant to seek medical care which increases the likelihood of delayed presentation and the need for an orchiectomy. This observational study sought to determine whether there was a higher number of testicular torsion cases during COVID-19.MethodsAs the first patient with COVID-19 was admitted to our facility on March 6, 2020, we identified male children ages 1–18 years with testicular torsion between March 1-December 31, 2020 (during COVID-19) compared to the same time period between 2015 and 2019 (prior to COVID-19). All patients were evaluated at our Institution's Emergency Department by a pediatric urologist.ResultsThere were 38 cases of testicular torsion between March 1-December 31, 2020 compared to 15.8 cases on average during the same 10-month period between 2015 and 2019 (a total of 79 cases). There was a statistically significant increase in testicular torsion cases during the COVID-19 pandemic compared to equivalent time periods in 2015–2019 (38 vs. 15.8, p = 0.05). Patients with testicular torsion during the COVID-19 pandemic were younger, had a longer duration of symptoms, and had a higher number of orchiectomies (although not statistically significant).ConclusionDuring the COVID-19 pandemic, an escalation in testicular torsion cases was observed. Timely assessment, diagnosis, and surgery are crucial to prevent testicular loss and potential infertility in the future. Further evaluation is needed to elucidate the surge in testicular torsion and possible mechanisms.     

The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review

Neurosurgical Review - The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This...     

The impact and lessons learnt from the COVID-19 pandemic on a UK Burns Centre

The COVID-19 pandemic has dramatically impacted healthcare provision in the UK and burns services have had to adapt to ensure the continuity of a safe care. As we return to “normality” we reflect on lessons learnt from our response to this pandemic.A service evaluation was performed from patient notes between March 23rd and May 8th 2020 and an anonymous survey given to patients attending outpatient appointments.258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused by treatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delay in referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majority of burns were managed conservatively (237/258). Dressing changes were performed at home by 32% of patients. The outreach team treated 22 patients.During the pandemic telemedicine has improved the efficiency of outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injury and to reassure them to seek help when burns occur.     

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis

International Urology and Nephrology - Obstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed...     

The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study

European Spine Journal - The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on...     

The impact of the COVID-19 pandemic on paediatric surgical volumes in Africa: A retrospective observational study

BackgroundThe aim of this study is to investigate the impact that COVID-19 had on the pattern and trend of surgical volumes, urgency and reason for surgery during the first 6 months of the pandemic in sub-Saharan Africa.MethodsThis retrospective facility-based study involved collection of paediatric operation data from operating theatre records across 5 hospitals from 3 countries: Zimbabwe, Zambia and Nigeria over the first half of 2019 and 2020 for comparison. Data concerning diagnosis, procedure, anaesthesia, grade, speciality, NCEPOD classification and indication was collected. The respective dates of enactment of cancellation policies in each country were used to compare changes in weekly median surgical case volume before cancellation using the Wilcoxon Sign-Rank Test.ResultsA total of 1821 procedures were recorded over the study period. Surgical volumes experienced a precipitous drop overall from a median of 100 cases/week to 50 cases/week coinciding with cancellation of surgical electives. Median accumulated weekly procedures before COVID-related cancellation were significantly different from those after cancellation (p = 0.027). Emergency surgery fell by 23.3% while electives fell by 78,9% (P = 0.042). The most common primary indication for surgery was injury which experienced a 30.5% drop in number of procedures, only exceeded by congenital surgery which dropped 34.7%.ConclusionsThe effects of surgical cancellations during the covid-19 pandemic are particularly devastating in African countries where the unmet need and surgical caseload are high. Continued cancellations that have since occurred will cause similar drops in surgical case volume that these health systems may not have the resilience to recover from.Level of EvidenceLevel II.