Impact of the COVID-19 pandemic on pediatric emergency department utilization for head injuries

Abstract

Head injuries are a leading cause of death and disability in children, accounting for numerous emergency department (ED) visits. It is unclear how the COVID-19 pandemic has influenced healthcare utilization for pediatric head injuries. We hypothesize that the proportion of ED visits attributable to head injury and severity will increase during the COVID-19 era. Retrospective study using electronic health record data to compare proportion and severity of head injury for children 0–21 years of age from three urban mid-Atlantic EDs in the pre-COVID-19 era (March–June 2019) and COVID-19 era (March–June 2020). Controlling for confounders, logistic regression analyses assessed ORs of head injury outcomes. The χ2 analyses identified differences in patient characteristics. The proportion of head injury visits within the ED population significantly increased during the COVID-19 era (adjusted OR (aOR)=1.2, 95% CI 1.1 to 1.4). Proportion of visits requiring hospitalization for head injury increased by more than twofold in the COVID-19 era (aOR=2.3, 95% CI 1.3 to 4.3). Use of head CT imaging did not significantly change in the COVID-19 era (aOR=1.0, 95% CI 0.7 to 1.6). The proportion of ED visits and hospitalizations for head injury increased during the COVID-19 era. This could be due to changes in the level of supervision and risk exposures in the home that occurred during the pandemic, as well as differences in postinjury care, level of awareness regarding injury severity, and threshold for seeking care, all of which may have influenced pediatric healthcare utilization for head injuries.

Mechanisms of bodily harm in emergency department youths with ADHD

“…We hypothesize this finding may be due to mechanisms of injury involved in different fracture patterns; while central fracture patterns are often found in motor vehicle accidents, upper limb fractures are common in sports and accidental falls, which are not known to be more common in patients with ADHD [9]. Skull and face fractures, which are included within central fractures, are a leading cause of disability in pediatric emergency department patients, and have become even more common since the start of the COVID-19 pandemic [5]. Given the increased propensity for central fractures in patients with ADHD, our findings suggest further investigation into injury prevention could benefit this vulnerable patient population.…”

“…Additional studies about severe injuries and mortality among the pediatric population in general suggest that it is indeed reasonable to inquire whether children with ADHD face a greater increased risk for severe injury and childhood mortality. Among these studies are statistics that show that unintentional injuries account for 44% of all injury deaths to children and adolescents [4], one of the most common types of severe injury in the pediatric emergency department is head injury [5], and >12,000 children die from injuries in the United States each year [6]. It is reasonable to suggest that the aforementioned mental health difficulties to which children with ADHD are predisposed can increase a pediatric patient with ADHD's risk for these unintentional injury deaths, severe head injuries, and injury deaths in general.…”

Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis

“…Some studies found a reduction in mild and severe trauma and fracture rates [18,19], with differences across age groups [20]. However, increases in specific injury patterns [21,22] as well as stable [23,24] and even raised rates of trauma-related visits [25] have also been reported. The effects of the pandemic on mental health emergency visits also appear to be complex, with accumulating evidence of an initial decrease during the first stage of public health response followed by a long-term increasing trend [26][27][28]; however, it is unclear whether these patterns are related to actual changes in pediatric populations' morbidity or simply reflect trends in overall health-care services usage and how they interact with PED attendance for other causes [29].…”