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Open Access

Infographic

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



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The International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics (IMPACT) was established in March 2020 to provide information about COVID-19 in orthopaedic patients.1 The IMPACT Hip Fracture Audits included two national and one international multicentre retrospective cohort studies, and a worldwide survey of clinical service disruption during the summer of 2020.2-4 A systematic review and meta-analysis examined the existing literature,5 and a number of observational studies examined COVID-19 in general and planned orthopaedics.6,7

IMPACT reported important findings that included: mortality risk associated with COVID-19 at the time of injury; risk factors for acquiring and dying of the disease; and the role of nosocomial transmission.8 This global collaboration highlighted practical lessons that might guide the research and audit response to future specialty-wide issues. Reporting standards for future studies are suggested and include adequate reporting of pathogen, healthcare, and patient factors.

Rapid collaboration and effective data-sharing were central to producing a dataset of sufficient size and diversity to answer urgent questions relating to COVID-19. A strategy for establishing collaborative clinical audits is outlined in order to improve the quality and robustness of future studies, facilitate audit-based investigation of topical issues using existing and common datasets, and permit a modern approach to health research using the meta-audit principles.9,10

These lessons are relevant to improving the evidence-based management of communicable disease outbreaks, including further COVID-19 waves, novel diseases, and seasonal viral illnesses such as norovirus and influenza. They will also inform the examination of wider topical issues, such as periprosthetic femur fractures, orthopaedic infection, and major geriatric trauma.

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Andrew J. Hall. E-mail:

References

1. Hall AJ . Scotland Makes an IMPACT on Global Clinical Audit . 2021 . https://www.shfa.scot.nhs.uk/Reports/_docs/2021/shfa-annual-report-2021-scotland-makes-an-impact.pdf ( date last accessed 12 May 2022 ). Google Scholar

2. Hall AJ , Clement ND , Farrow L , et al. IMPACT-scot report on COVID-19 and hip fractures: A multicentre study assessing mortality, predictors of early SARS-cov-2 infection, and the effects of social lockdown on epidemiology . Bone Joint J . 2020 ; 102-B ( 9 ): 1219 1228 . Crossref Google Scholar

3. Hall AJ , Clement ND , MacLullich AMJ , White TO , Duckworth AD . IMPACT-Scot 2 report on COVID-19 in hip fracture patients . Bone Joint J . 2021 ; 103-B ( 5 ): 888 897 . Crossref PubMed Google Scholar

4. Hall AJ , Clement ND , MacLullich AMJ , et al. IMPACT of COVID-19 on hip fracture services: A global survey by the International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics . Surgeon . 2021 ; S1479-666X(21)00092-5 . Crossref PubMed Google Scholar

5. Clement ND , Ng N , Simpson CJ , et al. The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: A systematic review and meta-analysis . Bone Joint Res . 2020 ; 9 ( 12 ): 873 883 . Crossref PubMed Google Scholar

6. Clement ND , Hall AJ , Makaram NS , et al. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery . Bone Joint J . 2020 ; 102-B ( 12 ): 1774 1781 . Crossref PubMed Google Scholar

7. Clement ND , Scott CEH , Murray JRD , Howie CR , Deehan DJ , IMPACT-Restart Collaboration . The number of patients “worse than death” while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic . Bone Joint J . 2021 ; 103-B ( 4 ): 672 680 . Crossref Google Scholar

8. Hall AJ , Clement ND , Ojeda-Thies C , et al. IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic . Surgeon . 2022 ; S1479-666X(22)00049-X . Crossref PubMed Google Scholar

9. Hall AJ , Duckworth AD , MacLullich AMJ , Farrow L , White TO , Clement ND . Meta-audit: a novel approach to healthcare improvement clinical audit and health data . Bone Jt 360 . 2021 ; 10 ( 6 ): 3 5 . Crossref Google Scholar

10. Johansen A , Ojeda-Thies C , Poacher A , et al. Developing a minimum common dataset for hip fracture audit to help counties set up national audits that can support international comparisons . Bone Joint J . 2022 . Google Scholar

Author contributions

A. J. Hall: Conceptualization, Project administration, Visualization, Writing – original draft, Writing – review & editing.

N. D. Clement: Conceptualization, Writing – review & editing, Supervision.

A. M. J. MacLullich: Writing – review & editing.

A. H. R. W. Simpson: Writing – review & editing.

A. Johansen: Writing – review & editing.

T. O. White: Writing – review & editing.

A. D. Duckworth: Conceptualization, Writing – review & editing, Supervision.

ICMJE COI statement

A. H. R. W. Simpson is the Editor-in-Chief of Bone & Joint Research, and reports institutional grants from RCUK, Charities, and Stryker, unrelated to this article. A. D. Duckworth reports research grants from NIHR, OTA, and SORT-IT, institutional grants from Stryker, Smith & Nephew, and Acumed, royalties from Elsevier and Taylor & Francis, a speaker payment from AgNovos Healthcare, all unrelated to this article. A. D. Duckworth is also an editorial board member of The Bone & Joint Journal, Bone & Joint Research, and Bone & Joint 360, an Associate Editor for Trials, OTAI, and JBJS Case Connector, and sits on the research committees for OTA Research and OTS Research. T. White reports royalties from Elsevier, unrelated to this article, and is President Elect of the Orthopaedic Trauma Society. A. J. Hall is an Honorary Research Fellow at the Scottish Hip Fracture Audit.

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Follow A. J. Hall @andrewhallortho, @IMPACTaudits

Follow A. M J. MacLullich @A_MacLullich

Follow A. Hamish R W. Simpson @EdinOrthopaedic

Follow T. O. White @EdinburghTrauma

Follow A. D. Duckworth @DuckworthOrthEd

© 2022 Author(s) et al.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/