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Changes in pediatric major trauma epidemiology, injury patterns, and outcome during COVID-19-associated lockdown
Naama Pines1, Miklosh Bala1, Itai Gross1
1Department of Pediatric Emergency Medicine, Hadassah and Hebrew University Hospital, Jerusalem, Israel.
Insights
During COVID-19 lockdowns, pediatric trauma visits dropped significantly, with fewer motor vehicle accidents but more burns and bicycle injuries. Trauma team capabilities must be maintained during future lockdowns.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Epidemiology
Background:
- The COVID-19 pandemic and associated lockdowns have altered pediatric emergency department admissions.
- Data on pediatric trauma epidemiology and injury patterns during lockdowns are limited.
Purpose of the Study:
- To analyze changes in pediatric trauma epidemiology and injury patterns during a COVID-19 lockdown period.
- To compare lockdown-period trauma data with pre-lockdown data from previous years.
Main Methods:
- Retrospective study at a single tertiary level 1 trauma hospital.
- Analysis of pediatric trauma cases (0-18 years) requiring trauma team activation (TTA).
- Comparison of data from a 5-week lockdown period (March-May 2020) with parallel periods in 2018-2019.
Main Results:
- A 40% decrease in TTA was observed during the lockdown (48 visits) compared to pre-lockdown periods (139 visits).
- Significant reductions in motor vehicle accident (MVA)-related injuries (34%) were noted.
- Significant increases in burn injuries (14%) and bicycle-related injuries (16%) occurred.
Conclusions:
- Lockdowns led to decreased overall pediatric trauma visits, primarily MVA-related, but increased burns and bicycle injuries.
- Findings suggest a need for public awareness programs on indoor hazards and outdoor activity risks.
- Maintaining trauma team capabilities is crucial, as PICU admissions and OR needs remained stable during lockdowns.
Introduction:
The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods.
Methods:
A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0-18 years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018-2019.
Results:
A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018-2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries (p = 0.0001) but a significant increase of 14% in burns (p = 0.01) and a 16% increase in bicycle-related injuries (p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed.
Conclusion:
There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.
