Public Health Risks and Characteristics of Upper Extremity Trauma During COVID-19
Condition: Upper Extremity Injury; COVID-19
MeSH terms: COVID-19; Arm Injuries
Study type: Observational [Patient Registry]

Summary: 
      The aim of this study was to evaluate for the first time in the Gaza-strip the
      characteristics and incidence of Upper Extremity Trauma (UET) during the COVID-19 pandemic.
      The participants, investigated the characteristics of UET cases, and evaluated the UET
      primary medical-care. Additionally, also evaluate the obstacles in treating UET in Gaza
      during the COVID-19 pandemic.
    

Detailed description: 
      Upper extremity trauma (UET) presenting to emergency departments (ED) incidence is rising.
      UET account for 20% to 40% of ED cases. UET affect daily function due to limited
      functionality of upper limb joints, nerves and muscles. The disability caused, affects
      psychological and social well-being, and major trauma may result in life changing long-term
      disability; Surgical site infection in UET is a possible cause of increased morbidity and
      mortality, leading to increased length of stay causing clinical and economic burden. UET in
      low income countries during armed conflict often causes a devastating decline in quality of
      life.

      In the United States (U.S.), UET was estimated to be about 10% of all traumas, with 37.2
      million cases, and estimated annual costs of 92 billion dollars; Over 2.7 million hand and
      wrist-related injuries/infections were presented to the ED nationwide; Pediatric nonballistic
      firearm UET cases in the U.S. represent a significant burden of disease. Electric scooters
      have also become an increasingly cause for UET. Interestingly, the current literature
      reflects a growing interest in sport related UET, as such sport related injuries may
      contribute to the growing incidence of UET worldwide.

      The overall UET incidence among U.S. military personnel (n=214,993) was 15 per 1,000 person
      years (<1%); UET are a common cause of morbidity and disability affecting military readiness,
      and imposing an economic burden. According to the United Nations Office for the Coordination
      of Humanitarian Affairs 2019 report, 87% of about 7,500 injuries during 17 months were
      classified as UET; The report estimated that about 18.5% of the injured require specialized
      limb reconstruction treatment, with individual treatment costs up to US$ 40,000; Leaving the
      healthcare needs with a growing funding gap due to the high toll of UET.

      UET reported during COVID-19 in the U.S. were significantly fewer in 2020 than in previous
      years; However, the odds of being admitted to the hospital when presenting with an UET were
      significantly greater. While traumatic injuries were less common during lockdowns, but the
      incidence of UET increased during COVID-19 quarantine in Italy. UET during COVID-19
      quarantine was a predominantly male-disorder (over 60%)mostly due to domestic traumas.During
      other times, the affected population was younger and the most common mechanisms were sport
      and traffic-related injuries.

      At the end of COVID-19 lockdowns a spike of UET incidence (158%) was reported in the United
      Kingdom due to young malesporting injuries predoninantly; Falls from <1.5 meters were the
      most common cause requiring surgical intervention. Additionally, UET operative volume
      increased during lockdowns in specialized trauma centers; and five types of behavior were
      identified as causes leading to those injuries that included (1) high-risk behavior and
      lawlessness, (2) virus-related suicidality , (3) lack of support due to social-distancing,
      (4) domestic renovations and carpentry, and (5) avoidance of health care facilities and delay
      in getting and treatment.

      UET has a full spectrum of presentations ranging from simple lacerations and cellulitis to
      complex amputations and necrotizing infections As UET prevalence rises there is a need to
      develop evidence-based changes to facilitate better UET management. Currently there is no
      ideal classification for UET, and even less information is available regarding complex
      traumatic UET. A major dilemma is presented by UET that requiring choosing between limb
      salvage and amputation. Comorbidities, pre-injury function and social situation must be
      considered, as well as surgical considerations (as amputations may present more favorable
      functional and psychological prognosis compared to lengthy complex salvage surgeries with
      high risk of unfavorable complications). A viewpoint published in the midst of the COVID-19
      pandemic stated that the public health infrastructural inadequacies led to a crisis in the
      Gaza-strip regarding sanitation, hygiene, waste treatment and water supply; Thus exposing
      Gaza's population to more epidemiological risks and disease outbreaks.
    

Intervention name(s): X-ray, CT
Intervention type(s): Diagnostic Test
Intervention description(s): Just a diagnostic procedure to confirm the diagnosis
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All Upper Extremity trauma who arrived to ED and need addmission to the surgical ward
      
Keywords: Upper Extremity Trauma