Background Impact of social distancing on pediatric injuries is unknown. Methods We retrospectively compared injury visits to a pediatric emergency department by individuals ≤21 years during “Stay at Home” (SHO) period to the same period in 2019 (non-SHO). Demographics, types, and outcomes of injuries were noted. Results Although, there was a 35.6% reduction in trauma-related emergency department visits during SHO period (1226 vs 1904), the proportion of injury visits increased (15.5% vs 8.1%, P < .001) and mean age was lower (5.8 yrs ±4.5 vs 8.4 yrs ± 5.2, P < .001). There were significant increases in visits related to child physical abuse (CPA), firearms, and dog bites. Further, significant increases in trauma alerts ( P < .01), injury severity ( P < .01), critical care admissions ( P < .001), and deaths ( P < .01) occurred during the SHO period. Conclusions Although overall trauma-related visits decreased during SHO, the proportion of these visits and their severity increased. Trauma visits related to child physical abuse, dog bites, and firearms increased. Further studies are required to assess the long-term impact of pandemic on pediatric trauma epidemiology.

Highlights Emergency Department and trauma visits decreased during COVID-19 pandemic Proportion of burn visits and severity increased during Stay at Home Order period There was a significant increase in proportion of house fire related burns Community reeducation about safety measures to prevent burn injuries is critical

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Epidemiologic study, level V.

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Some physicians feel gastric injury is not a significant contributing factor to the adverse outcome of trauma patients, but rather a marker of epigastric injury. We hypothesized the addition of a gastric injury to multiple injured trauma patients would increase infection rate. We conducted a retrospective study comparing 450 consecutive patients with full-thickness gastric injury with 983 patients without gastric injury during the same time period. Infection rate in patients with gastric injury was 44 per cent (200 of 455) and significantly higher than 36 per cent (357 of 983) seen without gastric injury (P = 0.006). Logistic regression revealed gastric injury was an independent risk factor for infection controlling for age, Injury Severity Scale, gender, mechanism of injury, shock, and associated injuries (P = 0.047). Requiring a transfusion, Injury Severity Scale, colon injury, age, pancreas injury, and emergency department shock were also independent risk factors for developing an infection. The addition of a gastric injury to a trauma patient appears to increase the risk for infection.

BackgroundThere is little consensus on the management of dog bite victims. Few studies have examined long-term patient outcomes. This study was designed to evaluate two outcomes: infection and unfavorable scar formation.MethodsA retrospective study of dog bite cases from January 2013 to May 2016 was conducted at our level I pediatric trauma center. Forty-five patients were identified who received definitive repair and had long-term follow-up for reasons other than rabies vaccination. Variables recorded were wound characteristics including presence of tissue loss, location in the hospital of the wound repair procedure, personnel performing the repair, postrepair infection, and a binary assessment of unfavorable scar formation.ResultsUnfavorable scarring was not significantly related to either repair location or personnel. Rate of infection was not significantly related to repair location. However, infection rate was significantly related to personnel performing the repair (p=0.002), with 8 of 11 (73%) infections after repair by emergency physicians compared with surgeons.DiscussionThe presence of infection was significantly related to bedside repair by emergency physicians. The data are suggestive of differences in wound preparation and repair technique between emergency department and surgical personnel. Standardizing technique could reduce infectious complications and long-term morbidity associated with repairing dog bites and other contaminated wounds. A robust and practical classification system for dog bite wounds would be helpful in stratifying these wounds for research comparison and healthcare triage.Level of evidenceThe level of evidence for this retrospective study is level III.

Literature on the role of cardiopulmonary resuscitation (CPR) and epinephrine in both adult and pediatric traumatic cardiac arrest (TCA) has been conflicting. [1][2][3][4] Studies have reported that despite CPR, provided in the pre-hospital or emergency department setting, survival rates of TCA patients remain poor. 1,2 Additional reports have suggested that while epinephrine may increase return of spontaneous circulation (ROSC) in TCA, it may negatively impact outcomes including long-term survival and favorable neurological outcome. 4 Thus, the impact of epinephrine and CPR in pediatric TCA is unclear and warrants further investigation.The objectives of this study were to describe the use of CPR and epinephrine in children with TCA and to compare the clinical characteristics between survivors and non-survivors.We performed a retrospective cohort study of children ≤18 years of age with TCA who were treated between January 1st, 2010, and December 31st, 2019 at the emergency department of one of the following three urban tertiary care hospitals: Site A: a pediatric center with 1200 annual injury related visits and Sites B and C: two regional adult trauma centers that collectively see approximately 2500 trauma visits per year, of which 17% are pediatric. Children with TCA who were evaluated at the two adult facilities, and subsequently transferred to the pediatric center, were only included once as part of their respective institutional cohort. Children with cardiac arrest due to medical causes and drowning were excluded. Patients were identified from a pre-existing trauma registry that is updated and maintained by trauma teams of all three hospitals. This database was queried for children evaluated for TCA during the study period. We defined TCA as cardiac arrest occurring secondary to an injury (blunt or penetrating). All data were extracted from the electronic medical record and transferred to an excel spreadsheet by a trained research assistant. Data extraction was reviewed for accuracy and context by the principal investigator. Information was collected on demographics, date of injury, type of injury (blunt vs penetrating), Injury Severity Score (ISS), CPR duration, pre-hospital management,