IMPACT-Scot 2 report on COVID-19 in hip fracture patients:a nationwide study of mortality, risk factors for community- and hospital-acquired COVID-19, and suggested care pathways

Abstract

Aims The primary aim was to determine the influence ofCOVID-19 on 30-day mortality in hip fracture. Secondary aims were to determine:(1) predictors of COVID-19 status on presentation and later in the admission; (2)rate of hospital-acquired COVID-19 and (3) the predictive value of negativeswabs on admission.Methods A nationwide multicentre retrospective cohort studywas conducted of all patients presenting with hip fracture to all 17 Scottishhospitals in March-April. Demographics, presentation blood tests, COVID-19status, Nottingham Hip Fracture Score, management, length of stay and 30-daymortality were recorded. Results 78/833 (9.4%) patients were diagnosed with COVID-19(65 positive test; 13 clinical diagnosis). 30-day survival of patients with COVID-19 was significantly lower than for those without (65.4% vs91%; p<0.001). Diagnosis ofCOVID-19 within 7 days of admission (likely community-acquired) wasindependently associated with male sex (OR 2.34, p=0.040, CI 1.04-5.25) and symptoms of COVID-19 (OR 15.56, CI6.61-36.60, p<0.001).  Diagnosis of COVID-19 within 7-30 days ofadmission (probable hospital-acquired) was independently associated with malesex (OR 1.73, CI 1.05-2.87, p=0.032), Nottingham Hip Fracture Score ³7 (OR 1.91, CI 1.09-3.34, p=0.024),pulmonary disease (OR 1.68, CI 1.00-2.81, p=0.049), American Society ofAnesthesiologists (ASA) grade ³3 (OR 2.37, CI 1.13-4.97, p=0.022) andlength of stay ³9days (OR 1.98, CI 1.18-3.31, p=0.009). 38 (58.5%) of COVID-19 cases wereprobable hospital-acquired infections. The false negative rate of a negativeswab on admission was 0% in asymptomatic patients, and 2.9% in symptomaticpatients. Conclusion COVID-19 wasindependently associated with a three times increased 30-day mortality rate. Nosocomialtransmission may have accounted for approximately half of all cases.Identification of risk factors for having COVID-19 on admission or acquiringCOVID-19 in hospital may guide pathways for isolating and shielded patients.Length of stay was the only modifiable risk factor, which emphasises theimportance of high quality, timely care.

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© 2022 The British Editorial Society of Bone & Joint Surgery.

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DOI

https://doi.org/10.1302/0301-620X.103B.BJJ-2020-2027.R1

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https://www.research.ed.ac.uk/en/publications/cf7129e2-62e3-428d-a452-78aa05853f3e