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National Epidemiologic Trends and Disparities in Operative Management of Pediatric Facial Soft Tissue Injuries
Victoria Kong1, Andrew Salib, Albert Rancu
1Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut.
Insights
Pediatric facial soft tissue injuries, including lacerations and bites, show age-related patterns. Racial disparities in surgical delays worsened during COVID-19, impacting potential outcomes.
Area of Science:
- Pediatric Trauma Surgery
- Facial Reconstructive Surgery
- Public Health Epidemiology
Background:
- Soft tissue injuries are common in pediatric facial trauma, but large-scale data are limited.
- This study provides the first national analysis of pediatric facial soft tissue injuries in the U.S.
Purpose of the Study:
- To analyze national-level data on pediatric facial soft tissue injuries.
- To assess injury patterns and treatment disparities before and during the COVID-19 pandemic.
Main Methods:
- Retrospective analysis of the American College of Surgeons Trauma Quality Improvement Project (ACS TQIP) database (2017-2022).
- Included 123,558 patients aged 0-18 years with facial soft tissue injuries.
- Multivariable regression models assessed pre- and during-COVID-19 patterns.
Main Results:
- Lacerations, bites, and puncture wounds were most common, with age-specific variations.
- Falls and environmental factors predominated in younger children; high-energy trauma in older children.
- Racial disparities in surgical delays increased during COVID-19, affecting Black and Asian children more than White children.
Conclusions:
- Worsening racial disparities in operative timing during COVID-19 may negatively affect pediatric facial outcomes.
- Highlights the need for prompt plastic surgery consultation and standardized referral pathways for sensitive facial injuries.
Introduction:
Soft tissue injuries comprise the majority of pediatric facial traumas, yet large-scale epidemiologic studies remain scarce. We present the first national-level analysis of pediatric facial soft tissue injuries in the United States.
Methods:
A retrospective study of the ACS TQIP (American College of Surgeons Trauma Quality Improvement Project) database from 2017 to 2022 examined 123,558 patients aged 0 to 18 years with facial soft tissue injuries. Patterns before and during COVID-19 were assessed using multivariable regression models.
Results:
The most prevalent injuries were lacerations, bites, and puncture wounds, with distinct age-related variation. Falls and environmental causes were common in younger children, while older children were disproportionately affected by high-energy trauma mechanisms, such as those from motor vehicle accidents and assaults. Overall, 49.7% received operative treatment. Black children experienced longer surgical delays (9.68±36.1 vs. 7.73±31.2 h for White children, P <0.001). During COVID-19, disparities worsened, with Asian children also experiencing significant delays (13.16±45.5 vs. 7.93±34.1 h for White children, P =0.013).
Conclusions:
Racial disparities in operative timing worsened during the COVID-19 pandemic, which may compromise long-term functional and aesthetic outcomes in the pediatric face. Our findings highlight the need for timely plastic surgery involvement in anatomically sensitive injuries and standardized referral pathways.
