Reduced Number of Pediatric Orthopedic Trauma Requiring Operative Treatment during COVID-19 Restrictions: A Nationwide Cohort Study

Abstract

Background and Aims: The coronavirus outbreak significantly changed the need of healthcare services. We hypothesized that the COVID-19 pandemic decreased the frequency of pediatric fracture operations. We also hypothesized that the frequency of emergency pediatric surgical operations decreased as well, as a result of patient-related reasons, such as neglecting or underestimating the symptoms, to avoid hospital admission. Materials and Methods: Nationwide data were individually collected and analyzed in all five tertiary pediatric surgical/trauma centers in Finland. Operations related to fractures, appendicitis, and acute scrotum in children aged above 16 years between March 1 and May 31 from 2017 to 2020 were identified. The monthly frequencies of operations and type of traumas were compared between prepandemic 3 years and 2020. Results: Altogether, 1755 patients were identified in five tertiary hospitals who had an emergency operation during the investigation period. There was a significant decrease (31%, p = 0.03) in trauma operations. It was mostly due to reduction in lower limb trauma operations (32%, p = 0.006). Daycare, school, and organized sports–related injuries decreased significantly during the pandemic. These reductions were observed in March and in April. The frequencies of appendectomies and scrotal explorations remained constant. Conclusion: According to the postulation, a great decrease in the need of trauma operations was observed during the peak of COVID-19 pandemic. In the future, in case similar public restrictions are ordered, the spared resources could be deployed to other clinical areas. However, the need of pediatric surgical emergencies held stable during the COVID-19 restrictions.

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study

“…In fact, the major part of our critical children arrived within 24 h since the onset of symptoms, suggesting that lockdown and fear of COVID-19 were not responsible for delayed provision of care. On the other hand, the results of an early single center report from Ireland [24] and other recent papers on the need for urgent surgery in large cohorts of children are consistent with our findings [ 20 , 21 ]. Often, critical patients were not brought to their general practitioners before attending EDs: we might suppose that families preferred to refer directly to hospitals (in particular the major ones) in order not to delay diagnosis and care.…”

“…Another consequence of community isolation and social restrictions was the reduction of admissions related to trauma and outdoor injuries. Interestingly, the decrease of pediatric trauma was stronger than reported in March and April in Finland (−24%) and the United States, where fracture reduction was 58% [ 20 , 21 ]. At the same time, we globally reported significantly lighter decrease of admissions due to surgical problems, compared to all the other subgroups, and proportional increase of need for urgent surgery only in hospitals without PICU.…”

The global burden of trauma during the COVID-19 pandemic: A scoping review

“…There was a worldwide reduction in the proportion of injuries occurring secondary to sporting activities, with the exception of the paediatric population described by Raitio et al‘s centre in Finland. 60 This is summarised in Fig. 2 d.…”

“…A reduction in trauma occurring secondary to RTCs was reported in the UK, 10 , 20 , 45 , 49 US 17, 26, 40, 51, 52, 55 , New Zealand, 12 Australia, 31 , 50 India, 53 , 57 Iran, 37 Hong Kong 58 and Europe. 13 , 19 , 22 , 36 , 59 , 60 These reductions reached statistical significance in Jacob et al‘s Australian centre (34% v 46%, p = 0.025), and Sherman et al‘s US centre (42% v 49%, p = 0.03). An increase in injuries from RTCs in children was reported by Bram et al in the US (5.2% v 1.8%) 11 and UK by Sugand et al (2% v 1%).…”

“…The reported proportion of patients undergoing operative management during the pandemic ranged from 1.4 to 90.4%. Reductions of between 18.9 and 44.2% were reported in centres in the UK, 54 , 66 US 11 , Europe 36 , 39 , 60 , 67 and Hong Kong. 58 However, increases in the proportion of patients managed operatively were noted in the UK, 10 Paris, 19 the US, 29 , 32 Australia 50 and India.…”