Trends in Lower Extremity Injuries Presenting to Emergency Departments During the COVID-19 Pandemic

BACKGROUND: During the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in U.S. emergency department (ED) volumes and acuity of patient presentation compared with more recent years. Objectives: The purpose of this study was to characterize the incidence of specific lower extremity (LE) injuries presenting to U.S. EDs during the COVID-19 pandemic and to analyze trends across age groups and rates of hospital admission compared with previous years. METHODS: The National Electronic Injury Surveillance System database was queried to identify patients who presented to U.S. EDs for a LE orthopedic injury between 2016 and 2020. RESULTS: These queries returned 252,656 cases, representing a total estimate of 9,740,514 injuries presenting to EDs across the United States. The mean incidence of LE orthopedic injuries was 596.8 injuries per 100,000 person-years (95% confidence interval [CI] 594.9–598.7), with the greatest annual decrease in incidence occurring between 2019 and 2020 (24.96%). The largest number of estimated hospital admissions occurred in 2020, with a total 181,671 admissions (95% CI 178,032–185,311), a 25.74% increase from the average number of admissions between 2016 and 2019. CONCLUSION: The COVID-19 pandemic has placed immense stress on both emergency medical services and hospital systems around the United States. While there were decreased rates of ED utilization for LE orthopedic complaints during the first year of the pandemic, there was a concomitant increase in both the number and proportion of these injuries admitted to the hospital from the ED. This places an additional burden on already stressed emergency medicine services and overall hospital systems that could slow down the management of medical emergencies.