{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:23:23Z","timestamp":1765729403201,"version":"3.48.0"},"reference-count":18,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UKRI\/MRC Rapid Response COVID trial","award":["MR\/V027883\/1"],"award-info":[{"award-number":["MR\/V027883\/1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,3,31]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>During the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity and minimise the inpatient risk of contracting COVID-19. This study aims to identify the excess death rate in this population during the first wave of the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A longitudinal cohort study of patients with fragility fractures identified by specific International Classification of Diseases (ICD)-10 codes. The first wave of the pandemic was defined as the 3-month period between 1 March and 1 June 2020. The control group presented between 1 March and 1 June 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two acute National Health Service hospitals within the East Midlands region of England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1846 patients with fragility fractures over the aforementioned two specified matched time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Four-month mortality of all patients with fragility fractures with a subanalysis of patients with fragility hip fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>832 patients with fragility fracture were admitted during the pandemic period (104 diagnosed with COVID-19). 1014 patients presented with fragility fractures in the control group. Mortality in patients with fragility fracture without COVID-19 was significantly higher among pandemic period admissions (14.7%) than the pre-pandemic cohort (10.2%) (HR=1.86; 95%\u2009CI 1.41 to 2.45; p&lt;0.001) adjusted for age and sex. Length of stay was shorter during the pandemic period (effect size=\u22124.2\u2009days; 95%\u2009CI \u22125.8 to \u20133.1, p&lt;0.001). Subanalysis of patients with fragility hip fracture revealed a mortality of 8.4% in the pre-pandemic cohort, and 15.48% during pandemic admissions with no COVID-19 diagnosis (HR=2.08; 95%\u2009CI 1.11 to 3.90; p=0.021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a significant increase in excess death, not explained by confirmed COVID-19 infections. Altered care pathways and aggressive discharge criteria during the pandemic are likely responsible for the increase in excess deaths.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058526","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T12:41:38Z","timestamp":1651840898000},"page":"e058526","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7520-6949","authenticated-orcid":false,"given":"Adeel","family":"Ikram","sequence":"first","affiliation":[{"name":"Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK"},{"name":"Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3735-1042","authenticated-orcid":false,"given":"Alan","family":"Norrish","sequence":"additional","affiliation":[{"name":"Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK"},{"name":"Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Ollivere","sequence":"additional","affiliation":[{"name":"Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8359-5705","authenticated-orcid":false,"given":"Jessica","family":"Nightingale","sequence":"additional","affiliation":[{"name":"Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK"},{"name":"Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1141-4471","authenticated-orcid":false,"given":"Ana","family":"Valdes","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nottingham, Nottingham, UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1410-1756","authenticated-orcid":false,"given":"Benjamin J","family":"Ollivere","sequence":"additional","affiliation":[{"name":"Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK"},{"name":"Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"key":"2025121408193892000_12.5.e058526.1","unstructured":"ONS Deaths involving COVID-19, England and Wales - Office for National Statistics. 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