The COVID-19 Pandemic: Effects on Pediatric Fracture Patterns in the Emergency Department and Subspecialty Follow-up Care

Abstract

Purpose: The COVID-19 pandemic affected pediatric fracture injury patterns and volume. There is a paucity of research evaluating this trend throughout the pandemic and also follow-up to orthopaedic subspecialty care after emergency fracture management. Methods: This retrospective cohort study reviewed patients 2 to 18 years of age presenting for fracture care to an urban pediatric emergency department. We assessed patient demographics, clinical care, and follow-up to surgical subspecialist. Time periods investigated included March 30 to September 4, 2020 (pandemic), March 30 to September 4, 2019, and March 30 to September 4, 2018 (prepandemic). Subanalysis within the pandemic was during the "stay-at-home order" verses the phased reopening of the state. Descriptive statistical analysis, Pearson's χ 2 or Fisher exact tests, and Mann-Whitney U tests were performed. Results: In this population, fractures overall declined by 40% (n = 211) during the pandemic compared with 2019 (n = 349) and 28% compared with 2018 (n = 292). Lower extremity fractures accounted for a greater percentage of injuries during the pan-demic compared with prepandemic. Time to surgical subspecialty follow-up was shortest during the 2020 pandemic peak at 9 days and was significantly longer during phased reopening (phase 1: 18 d, P = 0.001; phase 2: 14 d, P = 0.005). These patterns were also consistent for days to repeat imaging. Conclusions: We found differences in fracture prevalence, mechanisms, and follow-up care during the pandemic. Time to subspecialty follow-up care was longer during pandemic phased reopening despite overall fewer fractures. Plans to absorb postponed visits and efficiently engage redeployed staff may be necessary to address difficulties in follow-up orthopaedic management during public health crises. Level of Evidence: Level II.

Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review

“…In accordance with our results, most studies describe a decrease in the absolute numbers of treated patients or injuries during the lockdown in 2020 (Supplement, Table 8 ) and no significant change in the proportion of surgically managed patients (Supplement, Table 7 ) [ 1 – 4 , 13 , 14 , 33 – 37 ]. However, in a few studies, divergent changes in surgical management, with either a preference for non-operative management of lower leg fractures [ 38 ] or a significantly elevated frequency of operative treatment during the lockdown [ 12 , 39 , 40 ], are described.…”

“…In accordance with our results, in a study from Colorado, USA, there was no significant shift in the frequency of upper extremity fractures, lower extremity fractures, and axial/pelvic fractures [ 26 ]. However, some studies have shown a shift towards an increased occurrence of certain types of fractures in specific body regions [ 12 , 14 , 18 , 38 , 39 ] or a decrease in them [ 3 , 12 ]. Other studies have reported that wound therapy was more common during the pandemic, as our study did [ 3 , 8 , 16 , 20 ].…”

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

“…A tertiary hospital analysis found a 55% overall decline in procedures requiring anesthesia, with disproportionate reductions between inpatient and outpatient surgeries [ 61 ]. Another study reported a 40% decrease in pediatric fractures, although with increased time to subspecialty follow-up [ 72 ]. Researchers have also observed changes in ED care models during the pandemic, including more procedures for injuries, shorter stays, and increased appendicitis severity [ 30 ].…”