Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT05422989 |
| Other study ID # |
Upper Extremity Trauma |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
February 1, 2021 |
| Est. completion date |
June 15, 2022 |
Study information
| Verified date |
June 2022 |
| Source |
Islamic University of Caza, Gaza, Palestine |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational [Patient Registry]
|
Clinical Trial Summary
The aim of this study was to evaluate for the first time in the Gaza-strip the
characteristics and incidence of Upper Extremity Trauma (UET) during the COVID-19 pandemic.
The participants, investigated the characteristics of UET cases, and evaluated the UET
primary medical-care. Additionally, also evaluate the obstacles in treating UET in Gaza
during the COVID-19 pandemic.
Description:
Upper extremity trauma (UET) presenting to emergency departments (ED) incidence is rising.
UET account for 20% to 40% of ED cases. UET affect daily function due to limited
functionality of upper limb joints, nerves and muscles. The disability caused, affects
psychological and social well-being, and major trauma may result in life changing long-term
disability; Surgical site infection in UET is a possible cause of increased morbidity and
mortality, leading to increased length of stay causing clinical and economic burden. UET in
low income countries during armed conflict often causes a devastating decline in quality of
life.
In the United States (U.S.), UET was estimated to be about 10% of all traumas, with 37.2
million cases, and estimated annual costs of 92 billion dollars; Over 2.7 million hand and
wrist-related injuries/infections were presented to the ED nationwide; Pediatric nonballistic
firearm UET cases in the U.S. represent a significant burden of disease. Electric scooters
have also become an increasingly cause for UET. Interestingly, the current literature
reflects a growing interest in sport related UET, as such sport related injuries may
contribute to the growing incidence of UET worldwide.
The overall UET incidence among U.S. military personnel (n=214,993) was 15 per 1,000 person
years (<1%); UET are a common cause of morbidity and disability affecting military readiness,
and imposing an economic burden. According to the United Nations Office for the Coordination
of Humanitarian Affairs 2019 report, 87% of about 7,500 injuries during 17 months were
classified as UET; The report estimated that about 18.5% of the injured require specialized
limb reconstruction treatment, with individual treatment costs up to US$ 40,000; Leaving the
healthcare needs with a growing funding gap due to the high toll of UET.
UET reported during COVID-19 in the U.S. were significantly fewer in 2020 than in previous
years; However, the odds of being admitted to the hospital when presenting with an UET were
significantly greater. While traumatic injuries were less common during lockdowns, but the
incidence of UET increased during COVID-19 quarantine in Italy. UET during COVID-19
quarantine was a predominantly male-disorder (over 60%)mostly due to domestic traumas.During
other times, the affected population was younger and the most common mechanisms were sport
and traffic-related injuries.
At the end of COVID-19 lockdowns a spike of UET incidence (158%) was reported in the United
Kingdom due to young malesporting injuries predoninantly; Falls from <1.5 meters were the
most common cause requiring surgical intervention. Additionally, UET operative volume
increased during lockdowns in specialized trauma centers; and five types of behavior were
identified as causes leading to those injuries that included (1) high-risk behavior and
lawlessness, (2) virus-related suicidality , (3) lack of support due to social-distancing,
(4) domestic renovations and carpentry, and (5) avoidance of health care facilities and delay
in getting and treatment.
UET has a full spectrum of presentations ranging from simple lacerations and cellulitis to
complex amputations and necrotizing infections As UET prevalence rises there is a need to
develop evidence-based changes to facilitate better UET management. Currently there is no
ideal classification for UET, and even less information is available regarding complex
traumatic UET. A major dilemma is presented by UET that requiring choosing between limb
salvage and amputation. Comorbidities, pre-injury function and social situation must be
considered, as well as surgical considerations (as amputations may present more favorable
functional and psychological prognosis compared to lengthy complex salvage surgeries with
high risk of unfavorable complications). A viewpoint published in the midst of the COVID-19
pandemic stated that the public health infrastructural inadequacies led to a crisis in the
Gaza-strip regarding sanitation, hygiene, waste treatment and water supply; Thus exposing
Gaza's population to more epidemiological risks and disease outbreaks.
