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Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: A
Katherine T Flynn-O'Brien1, Amelia T Collings, Manzur Farazi
1From the Division of Pediatric Surgery, Department of Surgery (K.T.F., M.F., K.V.A., T.T.S.), Medical College of Wisconsin; Children's Wisconsin, Milwaukee, Wisconsin (K.T.F., M.F., K.V.A., T.T.S.); Division of Pediatric Surgery, Department of Surgery (A.T.C., M.P.L., T.A.M.), Indiana University, Indianapolis, Indiana; Norton Children's Hospital, Louisville, KY (M.E.F., D.S.F.); Hiram C. Polk, Jr Department of Surgery (M.E.F., D.S.F.), University of Louisville, Kentucky; Center for Surgical Outcomes Research (P.C.M., K.J.D.), Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine; Department of Pediatric Surgery (P.C.M., K.J.D.), Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery (K.E.S., S.G., N.R.), Mott Children's Hospital, Ann Arbor, Michigan; Department of Surgery (J.D.F., S.D.S.P.), Children's Mercy Hospital, Kansas City; Division of Pediatric Surgery (M.S.K.), Washington University School of Medicine, St Louis, Missouri; Division of Pediatric General and Thoracic Surgery (R.A.F.J., M.K.), Cincinnati Children's Hospital Medical Center; Department of Surgery (R.A.F.J., M.K.), University of Cincinnati College of Medicine, Cincinnati, Ohio; and Division of Pediatric Surgery, Department of Surgery (C.M.L.), University of Wisconsin, Madison, Wisconsin.
Insights
Pediatric injuries rose 20% during the COVID-19 pandemic. The link between social vulnerability and intentional injury also significantly increased, highlighting disparities in child safety.
Area of Science:
- Pediatric Trauma
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic's effect on pediatric injury rates, especially concerning community vulnerability, remains unclear.
- This study investigates changes in pediatric injuries during the pandemic's initial phase relative to the Social Vulnerability Index (SVI).
Purpose of the Study:
- To analyze the shift in pediatric injury incidence during the first six months of the COVID-19 pandemic.
- To specifically examine intentional injuries in relation to the Social Vulnerability Index (SVI).
Main Methods:
- Utilized data from the National Trauma Data Bank (2016-2020) for patients under 18 at nine Level I pediatric trauma centers.
- Compared a COVID-19 cohort (first 6 months of pandemic) with an averaged historical cohort (2016-2019) using multivariable logistic regression and interrupted time series analysis.
Main Results:
- A 20% increase in pediatric injuries was observed during the pandemic (p=0.031).
- Penetrating injuries, particularly firearm-related, and land transportation collisions (bicycles, ATVs) significantly increased.
- Social Vulnerability Index (SVI) was strongly associated with intentional injury (OR 7.9), with this association intensifying during the pandemic.
Conclusions:
- Pediatric injury rates escalated during the COVID-19 pandemic across various regions.
- The correlation between heightened community vulnerability and intentional pediatric injuries was amplified during the pandemic.
Background:
The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared with prior years, focusing on intentional injury relative to the social vulnerability index (SVI).
Methods:
All patients younger than 18 years meeting inclusion criteria for the National Trauma Data Bank between January 1, 2016, and September 30, 2020, at nine Level I pediatric trauma centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) was compared with an averaged historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed versus expected rates of injury were analyzed.
Results:
There were 47,385 patients that met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016 to 2019. The COVID cohort included 7,068 patients and the averaged historical cohort included 5,891 patients (SD, 472), indicating a 20% increase in pediatric injury ( p = 0.031). Penetrating injuries increased (722 [10.2%] COVID vs. 421 [8.0%] historical; p < 0.001), specifically firearm injuries (163 [2.3%] COVID vs. 105 [1.8%] historical; p = 0.043). Bicycle collisions (505 [26.3%] COVID vs. 261 [18.2%] historical; p < 0.001) and collisions on other land transportation (e.g., all-terrain vehicles) (525 [27.3%] COVID vs. 280 [19.5%] historical; p < 0.001) also increased. Overall, SVI was associated with intentional injury (odds ratio, 7.9; 95% confidence interval, 6.5-9.8), a relationship which increased during the pandemic.
Conclusion:
Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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