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BackgroundMelbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020).MethodsWe used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020.ResultsED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and ConclusionsOur analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne’s lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.

Background Hospitalised sport and active recreation injuries can have serious long-term consequences. Despite this, few studies have examined the long-term outcomes of these injuries. The purpose of this study was to establish whether patients hospitalised with orthopaedic sport and active recreation injuries, have returned to their pre-injury levels of health status and function, 12 months post injury and identify factors associated with poor outcomes. The present work was a cohort study with retrospective assessment of preinjury status and prospective assessment of outcome at 12 months post injury. Methods Adults with orthopaedic sport and active recreation injuries, captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Pre-injury and 12-month outcomes were assessed using the 36-item Short Form Health Survey (SF-36) and the extended Glasgow Outcome Scale. Differences in preinjury and post-injury SF-36 scores were examined and demographic, injury, hospital and physical activity variables were assessed for associations with outcome using multivariate linear regression. Results Of the 324 participants 98% were followed-up at 12 months post injury. At 12 months, participants reported a mean 7.0-point reduction in physical health (95% CI 5.8 to 7.8) and a 2.5-point reduction in mental health (95% CI 1.2 to 3.0), with 58% (95% CI 52.6% to 63.4%) reporting reduced function. Sporting group (p¼0.001), Injury Severity Score >15 (p¼0.007) and high pre-injury vigorous activity levels (p¼0.04), were related to poorer physical health outcomes. Conclusions At 12 months post injury, most participants reported large reductions in physical health and reduced function. This information is important for furthering our understanding of the burden of sport and active recreation injury and setting priorities for treatment and rehabilitation.

Background Serious sport and active recreation injuries are common with the potential for grave long-term consequences. Despite this few studies have examined the long-term outcomes of these injuries. Objective To establish if patients hospitalised with orthopaedic sport and active recreation injuries have returned to their pre-injury levels of health and function 12-months post-injury and to identify predictors of poor outcomes. Design Prospective cohort study with 12-month follow-up. Setting Two Level 1 trauma centres and one regional hospital in Victoria, Australia. Participants Adults with orthopaedic sport and active recreation injuries who were admitted to either Level 1 trauma centre between March 2008 and March 2009 or the regional hospital between June 2008 and June 2009 and captured by the Victorian Orthopaedic Trauma Outcomes Registry. There were 324 participants recruited to the study of which 98% were successfully followed up at 12-months post-injury. Assessment of risk factors Independent variables assessed for predictors of outcome were sporting group, age, sex, education level, major trauma classification (injury severity score>15) and injury patterns. Main outcome measurements The 36-item Short Form Health Survey (SF-36) and the Glasgow Outcome Scale Extended. Results At 12-months post-injury 58.1% of participants reported reduced function and a significant reduction in physical health (p Conclusion The findings of our study highlight that at 12-month post-injury, most patients injured during sport and active recreation had not returned to their pre-injury status. This information is useful for setting priorities for treatment and for the progression of sports injury prevention.

Background Sport and active recreation are important avenues for health enhancing physical activity. These health benefits can however be negated by injury. The impact of sport and active recreation injury on long term physical activity levels has yet to be investigated. Objective To evaluate the impact of serious sport and active recreation injury on patients9 long-term physical activity levels. Design Prospective cohort study with 12-month follow-up. Setting Two Level 1 trauma centres and one regional hospital in Victoria, Australia. Participants Adults admitted to hospital with orthopaedic sport and active recreation injuries and captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited from the two Level 1 trauma centres and one regional hospital over a 12-month time period. A total of 324 patients entered the study and 98% were followed up at 12-months post-injury. Assessment of risk factors Independent variables used in the analyses were sporting group, age, sex, education level, major trauma classification (Injury Severity Score>15), injury patterns and disability at 12-months post-injury. Main outcome measurement The International Physical Activity Questionnaire. Results At 12-months post-injury participants reported significant reductions in physical activity levels (p Conclusion Sport and active recreation injuries lead to significant reductions in physical activity levels, with potential negative health impacts in the future. The importance of sports injury prevention in maintaining population physical activity and the need to better understand why patients do not return to pre-injury activity levels is highlighted.