The Effect of COVID-19 on Pediatric Traumatic Orthopaedic Injuries: A Database Study

Abstract

Introduction: Stay-at-home orders and other social distancing restrictions had a profound effect on the lives of children during the pandemic. This study characterizes pediatric orthopaedic injuries and in-hospital outcomes during the COVID-19 pandemic and compares them with pre-COVID patterns. Methods: A retrospective review of pediatric patients presenting to hospitals with Pennsylvania Trauma Systems Foundation designations was performed. All patients younger than 18 years who presented with orthopaedic injuries were included. Patient demographics, injuries, hospital stays, and mortality were compared between the COVID and pre-COVID cohorts. Results: Overall, 1112 patients were included. During the pandemic, more injuries occurred at home (44.7% versus 54.9%, P = 0.01) and fewer at sporting areas, parks, and pools (7.8% versus 1.6%, P , 0.01) as well as at schools (3.4% versus 0.5%, P = 0.03). Injuries caused by child abuse were more prevalent during the pandemic (5.6% versus 11.0%, P , 0.01). Finally, the COVID cohort had a longer mean hospital length of stay (3.1 versus 2.4 days, P = 0.01), higher mean number of ICU days (1.0 versus 0.7 days, P = 0.02), and higher mortality rate (3.8% versus 1.3%, P = 0.02). Discussion: Pediatric patients sustained injuries in differing patterns during the pandemic, but these led to worse hospital outcomes, including higher mortality rates.T he COVID-19 pandemic has placed continued stress on patients and hospital systems across the United States. The increased time and economic burden caused by the increasing number of patients with severe acute respiratory syndrome coronavirus 2 has highlighted the need for more resources and better action plans. 1 Early in the pandemic, state and local governments placed stay-at-home orders and other social distancing restrictions, all aimed at curbing the spread of the virus. 2,3 Although this had a profound effect on the lives of the entire population, children, in particular, were forced to alter their lives drastically. Schools were closed,

Pediatric Trauma During the COVID-19 Pandemic: A 3-year Retrospective Analysis

“…Multiple other studies have demonstrated similar trends with decreased playground-related injuries and increased bicycle-related injuries during the pandemic. 6,19 Malige et al 20 found results coinciding with previous evidence demonstrating a decrease in injuries occurring at sporting areas, parks, and pools. Even though that study did not explicitly incorporate playgrounds into their findings, it showed changing child behavior during the pandemic leading to new patterns of injury.…”

“…Even though that study did not explicitly incorporate playgrounds into their findings, it showed changing child behavior during the pandemic leading to new patterns of injury. 20 Further knowledge relating to the particular mechanisms of injury could help to potentially prevent injuries in the vulnerable pediatric population during future societal events.…”

Quantifying the impact of the coronavirus 2019 pandemic on youth sports-related injuries in the USA

“…Regarding body region, patients sustained upper extremity (38.6%) and trunk (31.2%) injuries most commonly before the pandemic and there was no significant change in anatomic distribution of injuries during the pandemic. The pandemic also affected the location of sports-related injuries appearing to shift away from the 'sport' setting towards occurring at home and other alternative settings, a finding which has been demonstrated in prior work [9,11,[25][26][27].…”

Effect of the COVID-19 pandemic on emergency department attendances for pediatric injuries in Mozambique’s central hospitals: an interrupted time series and a comparison within the restriction periods between 2019 and 2020

“…Studies on pediatric populations from both high-income countries (HICs) and LMICs have reported that, in many instances, pandemic-related restrictions were associated with a reduction in certain types of injuries, such as road traffic injuries (RTIs) 15–17 or sports and leisure injuries, 15 18–22 and an increase in injuries that are more likely to occur in and around the home, such as burns 15 17 21–24 and certain types of falls from heights. 19–21 25 There are also indications of excess risk of violence-related injuries occurring at home, for example, injuries inflicted on children by either physical abuse and maltreatment 20 26–28 or sexual violence. 29–31 It is of note, however, that these differences are not consistent across studies and settings.…”

“…29–31 It is of note, however, that these differences are not consistent across studies and settings. 15 18 22 26 27 32 33 Furthermore, in addition to changes in the number and epidemiological characteristics, studies have shown an increase in injury severity during the pandemic, whether viewed by the nature of the injuries, 15 21 25 33 their severity, 16 21 22 25 the provision of intensive care unit (ICU) treatment, 20 21 25 27 or injury-related in-hospital mortality. 20 …”