PONE-D-21-10154Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemicPLOS ONE

Dear Dr. Kuitunen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Gabriel de Araújo, M.D., MSc

Academic Editor

PLOS ONE

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2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Although the number of emergency outpatients was reduced due to the lockdown, the number of surgeries did not seem to have changed significantly compared to before the pandemic. Since all patients can receive medical care in Finland's medical system, the strength of this study is that the numbers given in this study can be regarded as actual numbers.

On the other hand, compared to reports from other countries such as the United Kingdom and France, there seems to be little change in the number of emergency outpatients and the number of surgeries. This is thought to be affected by the number of people infected with COVID-19. In other words, since the number of COVID-19-infected persons is smaller in Finland than in France and the United Kingdom, it is considered that this pandemic had less impact on society such as emergency outpatient visits and surgery.

In this study, lockdown and regional restrictions are clarified in the figure, but it is easy for the reader to understand that they also include data on changes in the number of infected people in Finland.

Reviewer #2: This is an interesting and important research of the effect of COVID19 to hand trauma in Finland. Despite being a regional study, the enrollment is satisfactory in making generalization. As main findings, the researchers report that hand traumas decreased in the national lockdown, but thereafter increased to the reference level despite the later regional restrictions. Another important finding was that national lockdown didn't decrease the emergency operations.

The study is impotant and it adds the literature. The study is in the scope of the Journal. Language is good, the structure, figures and tables are sound. However, there are some minor point that I hope the authors would still consider for the revision:

- you conclude that all hand traumas have been treated in public hospitals. Perhaps some of them have been treated in private hospitals? This should be discussed in the manuscript, albeit it will not change the main findings and the value of the study.

- it is unclear, if the entire population, including children and adolescents, are included. There is variation in the study country regarding the in-hopsital treatment of childhood hand trauma; are they admitted to the dep. of pediatric surgery and orthopaedics or to the dep. of hand surgery. Please, define that in the revision.

- There has been one previous study of childhood trauma (including hand) in pediatric patients in the study country (A. Raitio et al, SJS 2020), which should be cited, to my opinion.

- Regarding the results, I think the incidence of replantantion emergency operations didn't change, while looking to the great confidence intervals of the IRRs. Therefore, the results and the conclusion concerning the change of IRR of replantantions should be re-written more carefully.

- It sounds little odd that summer cabin season starts in March in Finland. At the time of the first lockdown, the winter holidays were just starting. Perhaps some clarification about the large country and the potential variation in the study country, between the northern and southern parts of the country, could be added.

- As a part of final conclusions, I would like to see little more deductive speculation, why regional restrictions didn't decrease hand trauma.

In conclusion, this is very interesting study and I suggest publication after abovementioned minor repairs.

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Reviewer #1: No

Reviewer #2: Yes: Prof. Juha-Jaakko Sinikumpu

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PONE-D-21-10154R1Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemicPLOS ONE

Dear Dr. Kuitunen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 21 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Gabriel de Araújo, M.D., MSc

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Dear Author,

Your manuscript is good for publication, however the reviewer signed that the requested modification was not added.

I am waiting for your revision for a final decision.

Best regards,

Gabriel de Araújo

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: It is reported that the impact of COVID-19 on the hand trauma of the emergency outpatient clinic in Finland was small. Since the number of people infected with COVID-19 in Finland is smaller than in other countries, the impact of pandemic on daily life seems to be suppressed.

I commented last time that the number of COVID-19 infected people in Finland during study period should be included for reader to understand easily, but no data has been added.

Reviewer #2: I'm happy with the revision the authors have made. I recommend editor to accept the manuscript in this form.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemic

PONE-D-21-10154R2

Dear Dr. Kuitunen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Gabriel de Araújo, M.D., MSc

Academic Editor

PLOS ONE