Effect of COVID 19 pandemic on time to care, use of ambulance, admission characteristics, demography, injury characteristics, management and outcome of Paediatric Orthopaedic trauma patients admitted to the trauma centre







Pediatric, Orthopedic, Injury, COVID-19

Dimensions Badge



Original Article



Background: Lockdown imposed to limit the spread of COVID 19 may have had a significant effect on the time to care, demography, injury causation, injury characteristics, volume and nature of admission, management and outcome of paediatric orthopaedic trauma patients. Objective: To document the effect of lockdown on the time to care at KGMU, use of ambulance, volume and type of admissions, demography, injury causation, injury characteristics,  management and outcome of paediatric orthopaedic trauma patients. Methods:. This record review compared age, sex, type of admission, mechanism of injury, injury characteristics, type of treatment, vehicle used for transport, and outcome among patients admitted in pre-lockdown, lockdown and post lockdown.  Results: Lockdown was associated with decrease in the number of cases (p<0.01), increase in the time since injury to reception (p<0.040), a rise in the share of referred admission (p<0.040), time since reception at KGMU, time to definitive care (p<0.001), high energy falls (p<0.001), injuries at home (p<0.001), higher ISS (p<0.001), non operative treatment (p=0.038) and greater use of ambulance  (p=0.003). Conclusion: Lockdown resulted in a significant change in the causation and management of injury, significant delays in timeliness of care, reduction in the volume of admissions, an increase in injury severity and share of referral admissions.

How to Cite

Bharat A, Verma V, Afaque SF, Raikwar A, Chand S, Singh A. Effect of COVID 19 pandemic on time to care, use of ambulance, admission characteristics, demography, injury characteristics, management and outcome of Paediatric Orthopaedic trauma patients admitted to the trauma centre: https://doi.org/10.47203/IJCH.2022.v34i03.010. Indian J Community Health [Internet]. 2022 Sep. 30 [cited 2022 Sep. 30];34(3):374-80. Available from: https://iapsmupuk.org/journal/index.php/IJCH/article/view/2358


Download data is not yet available.


Li X, Liu M, Zhao Q, Liu R, Zhang H, Dong M, et al. Preliminary recommendations for lung surgery during COVID-19 epidemic period. Thorac Cancer. 2020;11:1372–1374..

Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease, 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9):577-582.

Annexure to Ministry of Home affairs order No 40-3/2020-D dated 24.03.2020. Guidelines on the measures to be taken by Ministries/Departments of Government of India, State/Union Territory governments and State/Union Territory authorities for containment of Covid epidemic in the country [cited 2022 Sep 09]. Available from https://www.mha.gov.in/sites/default/files/Guidelines_0.pdf

Guidelines for reopening [As per Ministry of Home affairs order No. 40-3/2020-DM-I (A) dated 30th September, 2020] [cited 2022 Sep 09]. Available at https://www.mha.gov.in/sites/default/files/MHAOrderDt_30092020.pdf

Li Y, Zeng L, Li Z, Mao Q, Liu D, Zhang L, et al. Emergency trauma care during the outbreak of corona virus disease 2019 (COVID-19) in China. World J EmergSurg 2020;15:33.doi:10.1186/s13017-020-00312-5.

Lv H, Zhang Q, Yin Y, Zhu Y, Wang J, Hou Z, et al. Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study. Injury 2020;51:1698–704. doi:10.1016/j.injury.2020.06.022

Zhu Y, Chen W, Xin X, Yin Y, Hu J, Lv H, et al. Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China. IntOrthop2020;44:1565–70. doi:10.1007/s00264-020-04575-0

Wong JSH, Cheung KMC. Impact of COVID-19 on orthopaedic and trauma service: an epidemiological study. J Bone Joint Surg Am 2020;102:e80. doi:10.2106/JBJS.20.00775

Balogh ZJ, Way TL, Hoswell RL. The epidemiology of trauma during a pandemic. Injury. 2020;51:1243–4. doi:10.1016/j.injury.2020.05.039.

Iyengar K, Vaish A, Vaishya R. Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic. J ClinOrthop Trauma. 2020;11:718–20.doi:10.1016/j.jcot.2020.05.010.

Casiraghi A, Domenicucci M, Cattaneo S, Maggini E, Albertini F, Avanzini S, et al. Operational strategies of a trauma hub in early coronavirus disease 2019 pandemic. IntOrthop. 2020;44:1511–8.

Haffer H, Schömig F, Rickert M, Randau T, Raschke M, Wirtz D, et al. Impact of the COVID-19 pandemic on orthopaedic and trauma surgery in university hospitals in Germany: results of a nationwide survey. J Bone Joint Surg Am 2020;102:e78. doi: 10.2106/JBJS.20.00756.

Joubert C, Desse N, Bernard C, Julien Cungi P, Bordes J, Dagain A. Indirect effects of the COVID19 pandemic in patients requiring neurosurgical care: will the second wave carry more severe neurosurgical patients? Br J Neurosurg 2022;36(1):124-26.

Kenanidis E, Tsiridis E. "Flattening the curve" of COVID-19 pandemic in orthopaedics and trauma: the Greek perspective. Injury. 2020;51:1681–82.

Lopez Martinez JJ, Rodríguez-Roiz JM, Salcedo Cánovas C. Musculoskeletal injuries secondary to exercise during confinement by the pandemic COVID-19. Med Clin. 2020;155:221–22.

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;51:1414–8. doi: 10.1016/j.injury.2020.05.016.

Salottolo K, Caiafa R, Mueller J, Tanner A, Carrick M M, Lieser M et al. Multicenter study of US trauma centers examining the effect of the COVID-19 pandemic on injury causes, diagnoses and procedures. Trauma Surg Acute Care Open 2021;6:e000655. doi:10.1136/tsaco-2020-000655.

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. N Z Med J 2020;133:81–88.

Way TL, Tarrant SM, Balogh ZJ. Med J Aust 2021; 214 (1): 38-39. |doi: 10.5694/mja2.50843.

Blackhall KK, Downie IP, Ramchandani P, Kusanale A, Walsh S, Srinivasan B, et al. Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study. Br J Oral MaxillofacSurg2020;58:698-703. doi: 10.1016/j.bjoms.2020.05.020.

Hadfield JN, Gray AC. The evolving COVID-19 effect on hip fracture patients. Injury 2020;51:1411–12. doi: 10.1016/j.injury.2020.06.006.

Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to perform trauma and orthopaedic surgery on patients with COVID-19. J Bone Joint Surg Am 2020;102:946–50. doi: 10.2106/JBJS.20.00454.

Phillips MR, Chang Y, Zura RD, Mehta S, Giannoudis PV, Nolte PA, Bhandari M. Impact of COVID-19 on orthopaedic care: a call for nonoperative management. TherAdvMusculoskelet Dis 2020 Jun 19;12:1759720X20934276. doi: 10.1177/1759720X20934276.

Stoker S, McDaniel D, Crean T, Maddox J, Jawanda G, Krentz N, Best J, Speicher M, Siwiec R. Effect of Shelter-in-Place orders and the COVID-19 pandemic on orthopaedic trauma at a community level II trauma center. J Orthop Trauma. 2020;34(9):e336-e342.

Helling TS, Watkins M, Evans LL, Nelson PW, Shook JW, Van Way CW. Low falls: an underappreciated mechanism of injury. J Trauma. 1999;46(3):453-56. doi: 10.1097/00005373-199903000-00019.

Bram JT, Johnson MA, Magee LC, Mehta NN, Fazal FZ, Baldwin KD, et al. Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic. J PediatrOrthop. 2020;40(8):373-379.

Sugand K, Park C, Morgan C, Dyke R, Aframian A, Hulme A et al. Impact of the COVID-19 pandemic on paediatricorthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the “golden weeks”, ActaOrthopaedica, 2020;91(6): 633-638. doi: 10.1080/17453674.2020.1807092.

Hayes DS, Holbert SE, Holbert JA, Seely MA, Suk M. Impact of COVID-19 on Pediatric and Adult Orthopaedics. 2020;3(2):221-227.

Calderon-Anyosa RJC, Kaufman JS. Impact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru. Prev Med. 2021;143:106331. doi: 10.1016/j.ypmed.2020.106331.

Khurshid A, Sohail A, Khurshid M, Shah MU, Jaffry AA. Analysis of Road Traffic Accident Fatalities in Karanchi, Pakistan. An autopsy based study. Cureus. 13(4):e14459. doi: 10.7759/cureus.14459.

Fahy S, Moore J, Kelly M, Flannery O, Kenny P. Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland. Bone Joint Open. 2020;6(1):261–266.

Qureshi AI, Huang W, Khan S, Lobanova I, Siddiq F, Gomez CR, et al. Mandated societal lockdown and road traffic accidents. Accid Anal Prev. 2020;146:105747. doi: 10.1016/j.aap.2020.105747.

Verma V, Singh GK, Kumar S, Sharma V, Gautam V, Kumar S. Direct (presenting primarily to trauma center) versus indirect (referred or transferred) admission of patients to the Trauma Centre of King George Medical University: One-year prospective pilot study. Int J CritIllnInj Sci. 2015;5(3):155-159. doi: 10.4103/2229-5151.164938.

Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083-1091. doi: 10.1016/j.injury.2006.07.009.

MacDonald DRW, Neilly DW, Davies PSE, Crome CR, Jamal B, Gill SL et al. Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland. Bone Jt Open 2020;1(9):541–548. doi: 10.1302/2633-1462.19.

Benazzo F, Rossi SMP, Maniscalco P, Moretti B, Vaienty E, Ruggieri P et al. The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. International Orthopaedics (SICOT). 2020; 44: 1453–1459. doi: 10.1007/s00264-020-04637-3.

Mathai NJ, Venkatesan AS, Key T, Wilson C, Mohanty K. COVID-19 and orthopaedic surgery: evolving strategies and early experience. Bone Jt Open. 2020;1(5):160–166. doi: 10.1302/2633-1462.15.

Luengo-Alonso G, Pérez-Tabernero FG, Tovar-Bazaga M, Arguello-Cuenca JM, Calvo E. Critical adjustments in a department of orthopaedics through the COVID-19 pandemic. IntOrthop. 2020;30:1–8. doi: 10.1007/s00264-020-04647-1.

Fatovich DM, Phillips M, Jacobs IG. A comparison of major trauma patients transported to trauma centers vs. non-trauma centers in metropolitan Perth. Resuscitation. 2011;82:560–3. doi: 10.1016/j.resuscitation.2011.01.016.

Helling TS, Davit F, Edward K. First echelon hospital care before trauma center transfer in a rural trauma system: Does it affect outcome? J Trauma. 2010;69:1362–6. doi: 10.1097/TA.0b013e3181d75250.

World Health Organisation. How India scaled up its laboratory testing capacity for COVID 19.August 2020 [cited 2022 Sep 09]. Available from https://www.who.int/india/news/feature-stories/detail/how-india-scaled-up-its-laboratory-testing-capacity-for-covid19

Most read articles by the same author(s)