Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis

Abstract

Background: The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. Purpose: To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort). Results: Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175). Conclusion: Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.

The influence of COVID-19 pandemic on the incidence of knee pain and physical activity level in children and adolescents in Japan: A prospective observation study

“…We are not able to explain the reason for this increase in knee pain prevalence among children, but this trend is similar to the result of a cross-sectional study that reported more musculoskeletal pain due to lifestyle changes among survivors of natural disasters [ 10 ]. Regarding musculoskeletal problems related to the COVID-19 pandemic, a cohort study in the USA showed a significant decrease in pediatric musculoskeletal injuries associated with sports [ 16 ]. Another cross-sectional study showed that 40% of participants with no previous back pain developed back pain during the COVID-19 pandemic [ 17 ].…”

Imaging volumes during COVID-19: A Victorian health service experience

“…Many patients and families deferred non-urgent imaging during the lockdown. Moreover, lockdown, home-schooling and suspension of group sports further reduced paediatric cases from sporting injuries[ 39 ]. We did observe a slight increase in some services, such as MRI, during 2020 despite COVID-19 disruption, as services returned to pre-COVID-19 demand.…”

The Impact of the COVID-19 Pandemic on Orthopaedic Knee Procedures: A National Multicentered Analysis

“…Most studies published in the literature analyzed the effects of COVID-19 on injuries and procedures during the initial months of the pandemic. A multicenter cohort study examined presentations of pediatric sports injuries, including meniscal and anterior cruciate ligament injury and patella dislocation, during the early (March to May 2020) and mid-pandemic (May to July 2020) period [ 17 ]. Within the first month of the pandemic, significant decreases in injuries were seen compared to pre-pandemic.…”

“…Additionally, no delay in care was observed for these injuries that occurred during the pandemic. Compared to pre-pandemic, more injuries occurred at home due to a decrease in organized sports and most occurred while playing basketball and soccer, which are easily played at home [ 17 ]. Interestingly, the lack of sports participation during the pandemic may result in increased injury rates upon return to play, as suggested by a German elite soccer league that experienced a three-fold increase in injury rates following the COVID-19 lockdown [ 18 ].…”

“…In a level 1 pediatric trauma hospital, there was a nearly 60% decrease in fracture volume during March-April 2020, but no significant difference in the proportion of any lower extremity fracture [ 20 ]. Additionally, studies have shown that pediatric fractures had no delay in presentation and treatment during the first few months of the pandemic [ 17 , 20 ]. All of these findings support the results of our study.…”