The IMPACT of COVID-19 in Trauma & Orthopaedic Surgery provides lessons for future communicable disease outbreaks: minimum reporting standards, risk scores, fragility trauma services, and global collaboration

Abstract

Reporting standards in studies of COVID-19 and other communicable diseases

Uncertainty surrounding the effects of the COVID-19 pandemic on hip fracture patients stimulated a large volume of original research articles, and the need for urgent dissemination of information resulted in heterogeneity of methodology and reporting.Adherence to reporting standards for future studies investigating COVID-19 would improve the quality of the evidence presented, and these should include: pathogen factors (e.g. prevalence, virulence, and effects); healthcare factors (e.g. infection prevention & control strategies, diagnostic criteria, and relevant public health policies), and patient factors (e.g. vaccination status, adjusting for comorbidity, and appropriate minimum follow-up duration).

A systematic review revealed variation in the methods used to diagnose COVID-19 in studies of hip fracture patients, with some classifying patients as COVID-19-positive based on clinical diagnosis only, which may have resulted in an inaccurate assessment of the prevalence of COVID-19. Antigen test techniques are now widely accessible, and future studies should be consistent in the reporting of laboratory tests for infection.

Nosocomial transmission appeared to play an important role in the spread of COVID-19 in the hip fracture population during the initial wave. However, there remains poor reporting of the timing of COVID-19 diagnosis in relation to the acute admission. Reliable assessment of the efficacy of infection prevention and control strategies is dependent on robust reporting of diagnosis date, especially when presenting data for 30-mortality following admission, and analysing the proportion of cases acquired beyond seven days of admission. There is poor reporting of follow-up duration in the existing literature, and the majority of studies examined patients up to 30 days post-admission rather than post-COVID-19 diagnosis. This inconsistency makes objective comparison of outcomes unreliable, and a minimum of 30 days of follow-up post-COVID-19 diagnosis is recommended for all future studies.

Original studies were conducted most frequently in Western Europe and North America during 2020 and, although these regions experienced a high prevalence of COVID-19, the literature may not be generalised to a broader sample of gender, race, ethnicity, healthcare systems, or geopolitical factors. The IMPACT-Global Hip Fracture Audit included patients from 14 countries spanning 6 continents, but further work is required to provide greater representation for patient groups in regions where hip fracture is becoming highly prevalent, particularly South-East Asia and South America.

Each study conducted on an inpatient population is dependent on the factors affecting the wider regional context. Future studies should report the contemporary background prevalence of the disease, the predominant SARS-Cov-2 variant of concern (VOC), as well as hospital and community public health and infection control policies relevant to transmission characteristics for their catchment population.

The majority of studies assessing the effect of COVID-19 on hip fracture patients report crude mortality rates and do not adjust for confounding factors that have been shown to affect outcomes. Future studies should consider adjusting analyses for patient factors including age, sex, BMI, frailty, and major pre-existing conditions including pulmonary or renal disease.

COVID-19 vaccinations have been available since late 2020 and there is encouraging evidence that they are effective at reducing transmission and disease severity, thus vaccine status of the patient should be reported in future studies. Consideration should be given wherever possible to the specific vaccination type, regimen and dates administered to patients as well as the predominant viral variant, as these factors may have a differential effect on outcomes.

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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DOI

https://doi.org/10.1302/2046-3758.116.BJR-2022-0060

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https://www.research.ed.ac.uk/en/publications/00a40e89-3131-4ab5-878c-3aee51607bad