The International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics (IMPACT) was established in March 2020 in order to provide clinicians and healthcare administrators with information about this novel disease and its effects on orthopaedic patients and services. The IMPACT Hip Fracture Audits included two national and one international multicentre retrospective cohort studies, and a worldwide survey of clinical hip fracture service disruption during the summer of 2020. A systematic review and meta-analysis examined the existing literature in order to inform the ongoing studies, and a number of additional observational studies examined COVID-19 in the context general and planned orthopaedics.
The IMPACT studies reported important clinical findings that included: the mortality risk associated with COVID-19 at the time of injury, the clinical risk factors for acquiring and dying of the disease, and the role of nosocomial transmission of infection. The conduct of this global collaborative work also highlighted practical lessons that might guide the research and audit response to future specialty-wide issues in orthopaedics.
Reporting standards for future studies are suggested and include the adequate reporting of pathogen, healthcare, and patient factors will improve the quality and utility of published evidence. A strategy for establishing collaborative clinical audits is outlined and includes recommendations regarding study design, governance, and delivery. Adherence to the suggested process may improve the quality, uptake, and robustness of future studies, and design that incorporates existing audit networks or makes use of existing common datasets may reduce project lead time and increase participation.
These lessons are relevant to improving the evidence-based management of further COVID-19 waves, novel communicable disease outbreaks, and the effects of seasonal viral illnesses such as those caused by norovirus and influenza.
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Hall, A., Clement, N., MacLullich, A., Simpson, A., White, T. & Duckworth, A. 2022, 'The delivery of an emergency audit response to a communicable disease outbreak can inform future orthopaedic investigations and clinical practice: lessons from IMPACT Hip Fracture Global Audits', Bone & Joint Research, 11(6), pp. 346-348. https://doi.org/10.1302/2046-3758.116.BJR-2022-0061