Background The Women’s and Children’s Hospital (WCH) in South Australia is a major tertiary referral teaching hospital with a Level 1 major paediatric trauma centre, receiving referrals from within South Australia and neighbouring states.

The setting for this study was unique as the hospital has no admitted cases of COVID-19 illness and, as such, this study represents the effects of government restrictions rather than the disease itself.

Objectives To evaluate the impact of the COVID-19 pandemic on paediatric orthopaedic services in a major paediatric tertiary hospital in South Australia.

Methods A retrospective audit was conducted of orthopaedic activity at a major paediatric tertiary referral hospital in South Australia, including a level 1 major paediatric trauma centre, for the period between 16 March 2020 and 26 April 2020 and compared with the corresponding time period in 2019 (18 March 2019 to 28 April 2019). Emergency Department (ED) presentations for musculoskeletal conditions, including fractures, were studied. Orthopaedic outpatient clinic, admission and operating theatre activity data were also assessed. No patients were admitted with COVID-19 illness at the hospital.

Results 621 paediatric patients presented to the ED with orthopaedic complaints during the 6-week period, compared to 997 in 2019, representing a 37.7% reduction. However, there was minimal change in the number of ED presentations requiring hospital admission (110 in 2020 versus 116 in 2019). Among patients discharged directly from ED, 27.3% received hospital outpatient referral (versus 39.1% in 2019), with the remaining patients referred to external health services including GP, mental health services or private heath providers) or discharged directly.

A total of 982 and 712 appointments (including face-to-face and telehealth) were scheduled in 2019 and 2020 respectively (table 3). 20.6% of patients failed to attend their appointments in 2020, up from 14.5% in 2019. There was a 509.8% increase in telehealth (video and phone) outpatient consultations compared to 2019 and a 60.6% decline in face-to-face appointments.

There was a total of 144 orthopaedic admissions (elective and emergency) compared to 184 in 2019, representing a 21.7% decline. Elective admissions were halved from 68 in 2019 to 34 while emergency admissions reduced by 5.2% from 116 to 110, demonstrating an overall shift in total workload towards emergency surgeries. Despite an overall downtrend in hospital admissions, elective and emergency admissions for children under 7 remained unchanged during the study period (32.5% reduction in children aged 7 and above).

Conclusions Musculoskeletal problems are the sixth most common presentation in children and adolescents and a better understanding of the impact of this pandemic provides guidance for planning in the face of future pandemics, or a second wave of COVID-19.

Despite an overall decline in all paediatric orthopaedic hospital activities, the number of emergency admissions for musculoskeletal conditions did not change. Elective and emergency admissions for children under 7 remained unchanged. There is a significant uptrend in the use of outpatient telehealth services. Appropriate planning and hospital resources allocation are necessary to meet this service requirement in future pandemics.