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Unintended Consequences of COVID-19 on Pediatric Falls From Windows: A Multicenter Study
Christina M Theodorou1, Erin G Brown1, Jordan E Jackson1
1University of California Davis Medical Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, California.
Insights
The rate of pediatric falls from windows nearly doubled during the COVID-19 pandemic
Area of Science:
- Pediatric Trauma
- Public Health
- Epidemiology
Background:
- Shelter-in-place orders during the COVID-19 pandemic increased time spent at home.
- Parents balanced childcare and work-from-home duties, potentially impacting child safety.
- Pediatric falls from windows represent a significant public health concern.
Purpose of the Study:
- To investigate the rate of pediatric falls from windows during the initial six months of the COVID-19 pandemic.
- To compare injury severity and outcomes between a COVID-era cohort and a pre-COVID cohort.
- To identify trends in pediatric trauma admissions related to falls from windows.
Main Methods:
- Retrospective review of pediatric trauma patients (<18 years) admitted to three trauma centers.
- Comparison of a COVID-era cohort (March 19, 2020 - September 19, 2020) with a pre-COVID cohort (March 19, 2019 - September 19, 2019).
- Primary outcome: rate of falls from windows. Secondary outcomes: injury severity score (ISS), injuries sustained, and mortality.
Main Results:
- The rate of pediatric falls from windows nearly doubled during the COVID-era (3.6%) compared to the pre-COVID era (2.1%), with an odds ratio of 1.7 (P=0.05).
- Most common injuries included skull fractures, extremity injuries, and intracranial hemorrhage.
- While overall trauma admissions decreased, falls from windows showed a significant increase in rate, with similar injury severity and surgical intervention rates between cohorts.
Conclusions:
- Despite fewer overall trauma admissions, the rate of pediatric falls from windows significantly increased during the COVID-19 pandemic.
- These findings suggest shelter-in-place orders may have had unintended consequences on child safety at home.
- Increased education on home safety and parental support are recommended to mitigate risks associated with falls from windows.
Introduction:
In attempts to quell the spread of COVID-19, shelter-in-place orders were employed in most states. Increased time at home, in combination with parents potentially balancing childcare and work-from-home duties, may have had unintended consequences on pediatric falls from windows. We aimed to investigate rates of falls from windows among children during the first 6 mo of the COVID-19 pandemic.
Methods:
Patients <18 y old admitted to three pediatric trauma centers (two - level 1, one - level 2) between 3/19/20 and 9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19 to 9/19/19). The primary outcome was the rate of falls from windows. Secondary outcomes included injury severity score (ISS), injuries sustained, and mortality.
Results:
Of 1011 total COVID-era pediatric trauma patients, 36 (3.6%) sustained falls from windows compared to 23 of 1108 (2.1%) pre-COVID era patients (OR 1.7, P = 0.05). The median ISS was seven pre-COVID versus four COVID-era (P = 0.43). The most common injuries sustained were skull fractures (30.5%), extremity injuries (30.5%), and intracranial hemorrhage (23.7%). One-fifth of patients underwent surgery (21.7% pre-COVID versus 19.4% COVID-era, P = 1.0). There was one mortality in the COVID-era cohort and none in the pre-COVID cohort (P = 1.0).
Conclusions:
Despite overall fewer trauma admissions during the first 6 mo of the COVID-19 pandemic, the rate of falls from windows nearly doubled compared to the prior year, with substantial associated morbidity. These findings suggest a potential unintended consequence of shelter-in-place orders and support increased education on home safety and increased support for parents potentially juggling multiple responsibilities in the home.
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