Auswirkungen der Corona-Pandemie auf den Patientenfluss orthopädisch-unfallchirurgischer Patienten in der Notaufnahme eines Krankenhauses der Maximalversorgung und Traumazentrums der Stufe 1
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Philipps-Universität Marburg
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Abstract
Clinical emergency medicine represents an obligatory link between outpatient and clinical care. The main focus is on the care of emergency patients with the highest possible standards of medical care quality. In this context, the utilization of emergency departments is steadily increasing both nationally and internationally. More low-acuity patients are presenting, as is evident in the increasing number of outpatients being cared for. Reports of overcrowded emergency departments and the associated negative consequences for the quality of care and the medical outcome are becoming more frequent.
After a cluster of pneumonia cases due to an unknown virus occurred in the Chinese province of Hubei in December 2019, the causative coronavirus SARS-CoV-2 spread in spring 2020 and led to COVID-19 cases worldwide. Starting with the first case at the end of January, steadily rising infection figures were also observed in Germany in the following weeks. Comprehensive packages of measures were adopted to protect against disease as well as to prevent overloading of the healthcare system. These included private contact restrictions, border closures as well as increased home office and short-time work. In order to reserve medical resources for infected patients, clinical routine was also restricted by postponing all suspendable and elective surgical procedures. As a result of the measures recorded, as well as the fear of infection, the number of presentations in German emergency departments changed. In the course of this, various specialties warned of an absence of emergency patients and delayed presentations during the pandemic. Data were not yet available for the absence of acute orthopedic trauma surgery patients.
This retrospective study was concerned with the question of the extent to which the presentations in the orthopedic trauma surgery central emergency department have changed compared to the previous year and whether there were indications of an absence of acute patients or a change in treatment urgency during the SARS-CoV-2 pandemic.
For this purpose, all presentations due to musculoskeletal complaints between March 16 and May 10 in 2020 and 2019 of the Central Emergency Department of the University Hospital Giessen and Marburg in Marburg from an age of 13 years were recorded. In addition to demographic characteristics, reaching the emergency department, leading symptoms, accident mechanisms, and further treatment were collected. Additionally, geriatric fractures were considered.
A total of 2,441 patient cases were included. Patient flow was found to have decreased by one third compared to the previous year (p<0.001). At the same time, comparable daily mean values of fractures (p=0.386), injuries requiring surgery (p=0.328) and polytrauma (p=0.322) were observed. Accordingly, the proportion of these characteristics raised (p<0.001; p<0.001; p=0.022). There was also an increase in the proportion of patients assigned by rescue services (p<0.001). A change was also found in the distribution of triage categories (p<0.001), with the daily means of the two highest categories not differing between years (p=0.674; p=0.317). Underlying accident mechanisms differed in that fewer work (p<0.001), sports (p<0.001), school (p<0.001), traffic (p=0.049653) and leisure accidents (p<0.001) occurred. The number of household accidents, on the other hand, remained unchanged (p=0.867). No differences were found for domestic violence (p=0.813) or self-inflicted injury (p=0.821). Geriatric fractures also did not differ (p=0.839).
Overall, this study showed that as a result of the pandemic as well as the associated measures, patient flow decreased significantly during the survey interval compared to the control period. It was also possible to identify clear effects of the restrictions on the accident mechanisms of work, school, sports, leisure and traffic. Further, the example of geriatric patients showed that the pandemic measures had a selective effect on presentation frequency according to the injury reality of the different patient groups. In conclusion, evidence of a pandemic-related absence of acute patients was lacking, as reflected by an overall increased urgency for treatment.
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Created: 2024Issued: 2025-06-04Updated: 2025-06-04
Faculty
Medizin
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Philipps-Universität Marburg
Language
ger
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DoctoralThesis
Keywords
NotaufnahmeOrthopaedicsUnfallchirurgieCOVID-19CoronavirusEmergency departmentOrthopädieCoronavirusTrauma surgeryCOVID-19
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610
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Klama, Niclas Renatus: Auswirkungen der Corona-Pandemie auf den Patientenfluss orthopädisch-unfallchirurgischer Patienten in der Notaufnahme eines Krankenhauses der Maximalversorgung und Traumazentrums der Stufe 1. : Philipps-Universität Marburg 2025-06-04. DOI: https://doi.org/10.17192/z2024.0355.
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