Impact of the COVID-19 pandemic on pediatric emergency department utilization for head injuries
Sanika Satoskar1, Oluwakemi B Badaki2, Andrea C Gielen3
1College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA.
Insights
The COVID-19 pandemic increased emergency department (ED) visits for pediatric head injuries and hospitalizations. This rise in head injury cases may stem from altered home supervision and risk exposures during the pandemic.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- Head injuries are a major cause of child mortality and disability.
- The impact of the COVID-19 pandemic on pediatric head injury healthcare utilization remains unclear.
Purpose of the Study:
- To investigate the changes in the proportion and severity of pediatric head injury emergency department (ED) visits during the COVID-19 pandemic.
- To compare healthcare utilization for pediatric head injuries between the pre-COVID-19 era and the COVID-19 era.
Main Methods:
- Retrospective study utilizing electronic health record data from three urban mid-Atlantic EDs.
- Comparison of pediatric patients (0-21 years) between March-June 2019 (pre-COVID-19) and March-June 2020 (COVID-19 era).
- Logistic regression and chi-squared analyses were used to assess outcomes and patient characteristics, controlling for confounders.
Main Results:
- The proportion of ED visits for head injuries significantly increased during the COVID-19 era (adjusted OR=1.2).
- Hospitalizations for pediatric head injuries more than doubled during the COVID-19 era (adjusted OR=2.3).
- Head CT imaging utilization remained unchanged (adjusted OR=1.0).
Conclusions:
- The proportion of ED visits and hospitalizations for pediatric head injuries rose during the COVID-19 pandemic.
- Potential contributing factors include changes in home supervision, risk exposures, and altered thresholds for seeking care.
- These findings highlight a significant shift in pediatric healthcare utilization for head injuries during the pandemic.
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.
