RT Journal Article SR Electronic T1 Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e054919 DO 10.1136/bmjopen-2021-054919 VO 12 IS 1 A1 Sugand, Kapil A1 Aframian, Arash A1 Park, Chang A1 Sarraf, Khaled M A1 YR 2022 UL http://bmjopen.bmj.com/content/12/1/e054919.abstract AB Objective This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.Design A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019.Setting Hospitals from six major urban cities were recruited around the UK, including London.Participants A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.Primary and secondary outcome measures Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used.Results During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon.Conclusion Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Underlying data, code and supporting documentation may be made available as a redacted version to interested parties, subject to the completion of a protocol and signing of a Data Transfer Agreement.