Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital

Abstract

Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our twoinstitution experience. Methods: Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015)(2016)(2017)(2018)(2019). Results: There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower ( p < 0.001) during COVID-19. Burn injury admissions ( p < 0.001) and penetrating trauma encounters ( p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased ( p < 0.001). Trauma occurred among more white ( p = 0.01) and privately insured ( p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes ( p < 0.001), pedestrians struck by automobile ( p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries ( p = 0.02), falls ( p < 0.001), and sports related injuries ( p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance ( p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era ( p = 0.04). For burn admissions, there was a significant increase in flame burns ( p < 0.001). Conclusions: Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.

COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

“…Sanford and colleagues [ 13 ] reported an overall change in pediatric injury and trauma pattern. Many authors reported a general decrease in blunt injuries due to the severe restriction rules adopted in each country [ 24 ].…”

“…This was probably related to the reduction of vehicle accidents and changes in childcare observation. By contrast, an increase in penetrating injuries and gun-related trauma was reported [ 13 , 25 ]. This data needs to be contextualized in a specific geographic area.…”

“…Traumatic injuries of children occurring at home are well reported in the literature, involving burns, fractures, contusions and traumatic wounds. Traumatic injuries are the primary cause of pediatric mortality and morbidity [ 13 ]. International studies reported overall changes in the pattern of pediatric trauma and injuries [ 13 ].…”

“…Traumatic injuries are the primary cause of pediatric mortality and morbidity [ 13 ]. International studies reported overall changes in the pattern of pediatric trauma and injuries [ 13 ].…”

COVID-19 and Pediatric Ingestions

“…1 Consequently, the abrupt shift in the school and home dynamics, combined with ensuing psychosocial and economic household stressors, placed children at increased risk of harm. 2 In particular, early 2020 data indicated an increase in household cleaner and disinfectant exposures. 3 However, the impact of the pandemic on overall pediatric ingestions is unclear.…”