Impact of the COVID-19 pandemic on osteoporotic vertebral fracture incidence and follow-up at the emergency department. A retrospective study of a tertiary hospital in southern Spain
1Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
2PhD. Programme in Clinical Medicine and Public Health, University of Granada, 18011 Granada, Spain
3School of Medicine, University of Glasgow, G12 8QQ Scotland, UK
4Department of Radiology and Physical Medicine, University of Granada, 18011 Granada, Spain
5Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain
Submitted: 27 August 2021 Accepted: 16 November 2021
Online publish date: 05 January 2022
The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.
COVID-19; Emergency department; Osteoporotic vertebral fracture; Post-discharge
Antonio J. Láinez Ramos-Bossini,Bárbara Láinez Millán,Fernando Ruiz Santiago,Mario Rivera-Izquierdo. Impact of the COVID-19 pandemic on osteoporotic vertebral fracture incidence and follow-up at the emergency department. A retrospective study of a tertiary hospital in southern Spain. Signa Vitae. 2022.doi:10.22514/sv.2022.002.
 World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-51. 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/ 20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 (Accessed: 11 October 2021)
 Government of Spain. Official State Bulletin. Royal Decree Law 463/2020, of March 14, declaring a State of Alarm for the management of the health crisis situation caused by COVID-19: 1–13. (in Spanish)
 Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, et al. Impact of the COVID-19 Pandemic on Emergency Department Visits - United States, January 1, 2019-May 30, 2020. MMWR. Morbidity and mortality weekly report. 2020; 69: 699–704.
 Boserup B, McKenney M, Elkbuli A. The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States. The American Journal of Emergency Medicine. 2020; 38: 1732–1736.
 Mantica G, Riccardi N, Terrone C, Gratarola A. Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear. Public Health. 2020; 183: 40–41.
 Green S, Barry C, Payne B, Holmes J, Xu T, Xu KT. Association between knowledge and attitude towards COVID-19 and utilization of emergency department care in Texas, United States: A hospital-based study. Journal of Health and Social Sciences. 2021; 6: 255–268.
 Baugh JJ, White BA, McEvoy D, Yun BJ, Brown DFM, Raja AS, et al. The cases not seen: Patterns of emergency department visits and procedures in the era of COVID-19. The American Journal of Emergency Medicine. 2021; 46: 476–481.
 Nuñez 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: 1414–1418.
 Wong JSH, Cheung KMC. Impact of COVID-19 on Orthopaedic and Trauma Service. Journal of Bone and Joint Surgery. 2020; 102: e80.
 Murphy T, Akehurst H, Mutimer J. Impact of the 2020 COVID-19 pandemic on the workload of the orthopaedic service in a busy UK district general hospital. Injury. 2020; 51: 2142–2147.
 Majumdar SR, Kim N, Colman I, Chahal AM, Raymond G, Jen H, et al. Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Archives of Internal Medicine. 2005; 165: 905–909.
 López Zúñiga D, Láinez-Ramos-Bossini AJ, Ruiz Santiago F. Radio-graphic diagnosis of osteoporotic vertebral fractures. An updated review. Medicina ClíNica. 2021. (in press)
 Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, López Zúñiga D. The role of radiography in the study of spinal disorders. Quantitative Imaging in Medicine and Surgery. 2020; 10: 2322–2355.
 Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Archives of Osteoporosis. 2013; 8: 136.
 Wáng YXJ, Santiago FR, Deng M, Nogueira-Barbosa MH. Identifying osteoporotic vertebral endplate and cortex fractures. Quantitative Imaging in Medicine and Surgery. 2017; 7: 555–591.
 Ross PD. Clinical consequences of vertebral fractures. The American Journal of Medicine. 1997; 103: 30S–43S.
 Lentle B, Trollip J, Lian K. The Radiology of Osteoporotic Vertebral Fractures Redux. Journal of Clinical Densitometry. 2016; 19: 40–47.
 McCarthy J, Davis A. Diagnosis and Management of Vertebral Compres-sion Fractures. American Family Physician. 2016; 94: 44–50.
 Láinez Ramos-Bossini AJ, López Zúñiga D, Ruiz Santiago F. Percu-taneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature. European Radiology. 2021; 31: 8542–8553.
 Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine Thoracolumbar Spine Injury Classification System. Spine. 2013; 38: 2028–2037.
 Ministerio de Sanidad, Consumo y Bienestar Social - Profesionales -Situación actual Coronavirus. Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/situacionActual.htm (Accessed: 23 August 2021).
 Peeters JJM, van den Berg P, van den Bergh JP, Emmelot-Vonk MH, de Klerk G, Lems WF, et al. Osteoporosis care during the COVID-19 pandemic in the Netherlands: a national survey. Archives of Osteoporosis. 2021; 16: 11.
 Kumar Jain V, Lal H, Kumar Patralekh M, Vaishya R. Fracture management during COVID-19 pandemic: a systematic review. Journal of Clinical Orthopaedics and Trauma. 2020; 11: S431–S441.
 Battisti S, Napoli N, Pedone C, Lombardi M, Leanza G, Tramontana F, et al. Vertebral fractures and mortality risk in hospitalised patients during the COVID-19 pandemic emergency. Endocrine. 2021; 74: 461–469.
 Dass D, Ramhamadany E, Govilkar S, Rhind JH, Ford D, Singh R, et al. How a Pandemic Changes Trauma: Epidemiology and Management of Trauma Admissions in the UK during COVID-19 Lockdown. Journal of Emergencies, Trauma and Shock. 2021; 14: 75–79.
 Dayananda T, Yasin T, Jemmett P, Trickett R. COVID-19: The Impact and Changes to Trauma Services in Cardiff. 2020. Available at: https: //www.boa.ac.uk/resources/knowledge-hub/covid-19-the-impact-and-changes-to-trauma-services-in-cardiff.html (Accessed: 23 August 2021).
 Atia F, Pocnetz S, Selby A, Russell P, Bainbridge C, Johnson N. The effect of the COVID-19 lockdown on hand trauma surgery utilization. Bone and Joint Open. 2020; 1: 639–643.
 Garude K, Natalwala I, Hughes B, West C, Bhat W. Patterns of Adult and Paediatric Hand Trauma during the COVID-19 Lockdown. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2020; 73: 1575–1592.
 Hampton M, Clark M, Baxter I, Stevens R, Flatt E, Murray J, et al. The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study. Bone & Joint Open. 2020; 1: 137–143.
 DiFazio LT, Curran T, Bilaniuk JW, Adams JM, Durling-Grover R, Kong K, et al. The Impact of the COVID-19 Pandemic on Hospital Admissions for Trauma and Acute Care Surgery. The American Surgeon. 2020; 86: 901–903.
 Stoker S, McDaniel D, Crean T, Maddox J, Jawanda G, Krentz N, et al. Effect of Shelter-in-Place Orders and the COVID-19 Pandemic on Orthopaedic Trauma at a Community Level II Trauma Center. Journal of Orthopaedic Trauma. 2020; 34: e336–e342.
 Morris D, Rogers M, Kissmer N, Du Preez A, Dufourq N. Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department in Kwa-Zulu Natal, South Africa. African Journal of Emergency Medicine. 2020; 10: 193–196.
 Christey G, Amey J, Campbell A, Smith A. Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. New Zealand Medical Journal. 2020; 133: 81–88.
 Martin-Playa P, Calzacorta-Muñoz P, Aparicio Elizalde L, Carrera-Casal O, García Gutiérrez JJ. An overview of the situation of hand surgery in Spain during the peak of COVID-19 pandemic. Hand Surgery and Rehabilitation. 2020; 39: 454–458.
 Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B. Excess mortality after hospitalisation for vertebral fracture. Osteoporosis International. 2004; 15: 108–112.
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