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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 18-22

Impact of Covid-19 lockdown measures on the burden of maxillofacial trauma cases: A record-based comparative study


Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India

Date of Submission08-Jan-2021
Date of Acceptance25-Jan-2021
Date of Web Publication29-Mar-2021

Correspondence Address:
Dr. P T Ikram Bin Ismail
Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_1_21

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  Abstract 

Background: The Covid-19 pandemic created a complex impact on the load of maxillofacial trauma cases worldwide. The exact effects of lockdown measures on the burden of maxillofacial trauma cases in India remain unknown. Aims and Objectives: The aim of this study was to assess the impact of Covid-19 lockdown measures on the burden of maxillofacial trauma cases reporting to the emergency department of Government Medical College, Kozhikode. Materials and Methods: A record-based comparative study was performed to assess the maxillofacial trauma cases among patients reported to the emergency department of Government Medical College, Kozhikode, Kerala from 25 March 2020 to 31 May 2020 (Lockdown group/Study group). This was compared with two control groups (pre-lockdown groups). Results: A total of 170 (10.4%) maxillofacial trauma cases were presented in the lockdown period, 723 (44.1%) cases during the pre-lockdown period, and 745 (45.5%) cases in the previous year (2019 period). There was a reduction of 35.1% and 33.7% in the number of maxillofacial trauma cases during lockdown period when compared with the respective counterparts. Conclusion: This study result will serve as a record for planning and implementing alternate protocols, identifying areas for improvement as well as re-distributing resources and manpower in times of future epidemics/pandemics.

Keywords: Covid-19, lockdown, maxillofacial trauma, pandemic


How to cite this article:
Ismail PI, Samson A, Soumithran C S, David Tharakan K R, Fasalulla O, Prem NS. Impact of Covid-19 lockdown measures on the burden of maxillofacial trauma cases: A record-based comparative study. Int J Oral Care Res 2021;9:18-22

How to cite this URL:
Ismail PI, Samson A, Soumithran C S, David Tharakan K R, Fasalulla O, Prem NS. Impact of Covid-19 lockdown measures on the burden of maxillofacial trauma cases: A record-based comparative study. Int J Oral Care Res [serial online] 2021 [cited 2021 Aug 6];9:18-22. Available from: https://www.ijocr.org/text.asp?2021/9/1/18/312531




  Introduction Top


Disease caused by novel coronavirus strain in 2019, also called COVID-19, is the latest infectious disease that has rapidly spread worldwide. An epidemic of viral origin was detected in Wuhan, China in late 2019, which was later declared as global pandemic by the World Health Organization (WHO) in March 2020. Subsequently, by the end of March, the Governments of many countries placed their countries on lockdown as a containment strategy.[1]

In India, the first positive case of the novel coronavirus was reported from Kerala and later, it spread to the other parts of the country as well. As the number of COVID-19 cases started spiking up, the Government of India ordered a complete nationwide lockdown for 21 days, starting from the midnight of 24 March 2020. To handle the worsening of pandemic in the country, government urged Indian states and citizens to strictly follow the social distancing measures as a preventive strategy.[2]

Under the nationwide lockdown, all places of social gatherings such as restaurants, cinemas, schools, shopping complexes, and educational institutions were closed. Employees and students were asked to work from home to avoid crowds. All types of transportation services, including rail, road, and air, were suspended, with exceptions for essential services. Furthermore, nearly all manufacturing and industrial activities were shutdown. The COVID-19 outbreak led to the deserted streets and empty roads as everyone, except those performing basic services, was asked to stay indoors during the lockdown. Moreover, there was a complete ban on alcohol sale.[3]

Because of the increasing industrialization and urbanization, maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide.[4],[5],[6] According to Adekeye,[7] maxillofacial injuries are increasing in frequency and severity because of the heavy reliance on road transportation and the increasing socioeconomic activities of the population. The COVID-19 pandemic created a complex impact on the load of maxillofacial trauma cases worldwide.[8] The exact effects of lockdown measures on the burden of maxillofacial trauma cases in India remain unknown. Hence, this study was undertaken to assess the impact of Covid-19 lockdown measures on the burden of maxillofacial trauma cases reporting to the emergency department of Government Medical College, Kozhikode, Kerala.


  Materials and Methods Top


A record-based comparative study was performed to assess the maxillofacial trauma cases among patients reported to the emergency department of Government Medical College, Kozhikode from 25 March 2020 to 31 May 2020 (Lockdown group/Study group). This was compared with two control groups (pre-lockdown groups).

Control group 1: Patients reported during the 10 weeks’ period leading up to lockdown in India (16 January 2020 to 24 March 2020);

Control group 2: Patients reported during the corresponding 10 weeks’ period during the previous year (25 March 2019 to 31 May 2019).

Sample size

All patients reported with maxillofacial injuries presented to the emergency department of Government Medical College, Kozhikode, during the above-mentioned time periods.

Inclusion criteria

All maxillofacial trauma cases reported to the emergency department of Government Medical College, Kozhikode, during the above-mentioned time periods.

Exclusion criteria

  1. Maxillofacial trauma cases not seen by the OMFS team;


  2. Patients with incomplete data for analysis.


The cases include self-presentations, those referred from other specialties, those referred from peripheral hospitals, and cases brought by trauma volunteers. The OMFS casualty register was the only source of data.

Study procedure

Permission to access register data was obtained from the Head of the Emergency Department, Government Medical College, Kozhikode, Kerala. Ethical clearance was obtained from the Institutional Ethics Committee bearing a registration number 182/2020/DCC. Data variables included in this study were patient demographics, number and percentage of trauma, nature of injury, and mechanism of injury. Contusions, soft tissue injuries, dento-alveolar injuries, mandible fractures, midface fractures, and multiple facial fractures were assessed under the variable “nature of injury.” Mechanism of injury were sub-categorized as motor-vehicle accidents, fall, assaults, sports injuries, work site injuries, animal bites, and miscellaneous.

Statistical analysis

Data analysis was carried out using IBM SPSS (Statistical Package for Social Sciences) Version 21.0, Chicago, IL, USA. Descriptive measures and χ2 test were conducted separately for each variable.


  Results Top


A total of 170 (10.4%) maxillofacial trauma cases were presented in the lockdown period, 723 (44.1%) cases during the pre-lockdown period, and 745 (45.5%) cases in the previous year (2019 period). There was a reduction of 35.1% and 33.7% in the number of maxillofacial trauma cases during lockdown period when compared with the respective counterparts. Analysis of gender revealed a slight male predominance in all the three groups, which was found to be statistically insignificant (p-value =0.95), as shown in [Table 1] and [Figure 1].
Table 1: Distribution of gender among the study group and control groups

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Figure 1: Distribution of gender among the study group and control groups

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Analysis in relation to mechanism of injury revealed that motor vehicle accidents were the most common cause of maxillofacial trauma in both the control groups, whereas in the study group, the highest number of trauma cases was due to fall. Among 688 motor vehicle accidents, 297 cases (44.5%) were reported in the year 2019, 321 cases (48.1%) in the pre-lockdown period, and 50 cases (7.5%) in the lockdown period. Statistically significant reduction (p-value =0.001) was observed in all the sub-categories of mechanism of injury during the lockdown period when compared with the control groups. The least number of trauma cases was reported from animal bites in all the three groups, as shown in [Table 2] and [Figure 2].
Table 2: Distribution of mechanism of injury among the study group and control groups

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Figure 2: Distribution of mechanism of injury among the study group and control groups (p-value = 0.001)

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Analysis of type of injury revealed that the most common type of maxillofacial trauma reported in all the three groups was laceration. A total of 247 cases (43.6%) of laceration were reported in the year 2019, 263 cases (46.5%) in the pre-lockdown period, and 56 cases (9.9%) in the lockdown period. Statistically significant reduction (p-value =0.001) was observed in all types of injuries during the lockdown period when compared with the control groups, with pan facial fracture being the least common type of injury reported in all the three groups [Table 3] and [Figure 3].
Table 3: Distribution of type of injury among the study group and control groups

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Figure 3: Distribution of type of injury among the study group and control groups

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  Discussion Top


On 24 March 2020, the Indian government commenced a national lockdown in an attempt to “flatten the curve” of Covid-19 spread. While the goal of this lockdown was to curtail the spread of this deadly pandemic, it appears to have effects on the incidence of maxillofacial trauma cases. To the best of our knowledge, this was the first study in India assessing the variations in the overall burden among maxillofacial trauma cases at three different time periods: lockdown, pre-lockdown, and in the previous year.

The results from our study suggested that there was a marked reduction in the number of maxillofacial trauma cases in the lockdown period when compared with the pre-lockdown times. The public adherence to lockdown guidelines is likely the primary contributing factor to the significant reduction in the number of major traumatic presentations during lockdown, which was in accordance to the study conducted by Rajput et al.[9] Moreover, the wide-spread anxiety among the general population about contracting Covid-19 has likely reduced their traumagenic behavior leading to 35.1% and 33.7% reduction in overall maxillofacial trauma cases when compared with the year 2019 and pre-lockdown times.

Variation was seen in the mechanism of injury when comparison was made with data from 2019 and pre-lockdown times. Significant reduction in road traffic accidents, injuries from sports and recreation, smaller reductions in injuries resulting from assaults, work site injuries, and animal bites was observed in our study which was in accordance with the study conducted by Fahy et al.,[10] in which similar presentation of trauma cases was observed in the lockdown period. In our study, we have observed that the highest number of trauma cases was due to “fall” in the lockdown group which gave an insight into the increased occurrence of domestic injuries due to mechanical falls, falls downstairs, and falls from ladders, which is in line with the study conducted by Fahy et al.[10]

The limitations of this study are the short study period and single-center experience. A larger, multi-centered study encompassing trauma patterns during lockdown will provide strength to the study. There is chance of increased, unreported, non-presenting self-harm and cases due to social isolation during lockdown, which in turn affects the mental health of a person. However, we have not extended this study to assess this.

The findings of this study have important public health implications. The rates of injuries due to fall were proportionally high in the study group which suggested that home is the still the most common site of injury and falls from a less than 2 m in height are the most common injurious mechanism. The need for a public health initiative to reduce the risk of falls at home has to be implemented by the Indian government. Thus, this study result will serve as a record for planning and implementing alternate protocols, identifying areas for improvement as well as re-distributing resources and manpower in times of future epidemics/pandemics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prakash O, Prajapati VK, Shahi AK, Khaitan T Incidence of maxillofacial trauma amid CoViD-19: A comparative study. J Maxillofac Oral Surg2020:1-6. doi: 10.1007/s12663-020-01484-y.  Back to cited text no. 1
    
2.
Kumari P, Toshniwal D Impact of lockdown measures during COVID-19 on air quality – A case study of India. Int J Environ Health Res2020;1-8.doi: 10.1080/09603123.2020.1778646.  Back to cited text no. 2
    
3.
Gautam S The influence of COVID-19 on air quality in India: A boon or inutile. Bull Environ Contam Toxicol 2020;104:724-6.  Back to cited text no. 3
    
4.
Ajike SO, Adebayo ET, Amanyiewe EU, Ononiwn CN An epidemiologic survey of maxillofacial fractures and concomitant injuries in Kaduna, Nigeria. J Surg Res 2005;7:251-5.  Back to cited text no. 4
    
5.
Sojot AJ, Meisami T, Sandor GK, Clokie CM The epidemiology of mandibular fractures treated at the Toronto General Hospital: A review of 246 cases. J Can Dent Assoc 2001;67:640-4.  Back to cited text no. 5
    
6.
Majumder B, Karmakar R, Bose T, Dasgupta S, Basu R Some host factors and seasonal variations in the fatal road traffic accidents occurring in eastern suburban Calcutta. Indian J Public Health 1996;40:46-9.  Back to cited text no. 6
    
7.
Adekeye EO The pattern of fractures of the facial skeleton in Kaduna, Nigeria. A survey of 1,447 cases. Oral Surg Oral Med Oral Pathol 1980;49:491-5.  Back to cited text no. 7
    
8.
Morris D, Rogers M, Kissmer N, Du Preez A, Dufourq N Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department in KwaZulu-Natal, South Africa. Af J Emerg Med 2020;10:193-6.  Back to cited text no. 8
    
9.
Rajput K, Sud A, Rees M, Rutka O Epidemiology of trauma presentations to a major trauma centre in the North West of England during the COVID-19 level 4 lockdown. Eur J Trauma Emerg Surg 2020:1-6. doi: 10.1007/s00068-020-01507-w.  Back to cited text no. 9
    
10.
Fahy S, Moore J, Kelly M, Flannery O, Kenny P Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland. Bone Jt Open 2020;1:261-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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