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Changes in pediatric unintentional injury hospitalizations before and after the COVID-19 pandemic: a retrospective
Tian Tang1,2, Shaojun Li1,2, Lin Yang1,2
1Department of Emergency Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Insights
Hospitalizations for unintentional injuries in children decreased post-COVID, with shifts in injury types and demographics. Prevention strategies need continuous updates to address evolving pediatric injury trends.
Area of Science:
- Pediatric epidemiology
- Injury prevention
- Public health
Background:
- Unintentional injuries (UI) are a major cause of childhood morbidity.
- The COVID-19 pandemic significantly altered children's environments and activities.
- Understanding pandemic-related shifts in pediatric UI is crucial for public health.
Purpose of the Study:
- To analyze epidemiological characteristics and trends of pediatric unintentional injury hospitalizations before and after the COVID-19 pandemic.
- To identify changes in injury mechanisms, patient demographics, and clinical outcomes.
- To inform targeted injury prevention strategies.
Main Methods:
- Retrospective review of 51,591 unintentional injury hospital admissions.
- Data collected from a university-affiliated children's hospital.
- Analysis of trends across pre-pandemic (2015-2019) and post-pandemic (2020-2024) periods, stratified by age groups.
Main Results:
- Overall UI hospitalizations decreased post-pandemic, with notable drops in 2020 and 2022.
- Shift in age distribution towards older children and adolescents; increased proportion of female and urban patients.
- Fall/slips remained common; foreign body ingestions decreased in infants, while adolescent poisonings increased.
- Traffic accidents led to highest ICU admissions and costs; clinical outcomes improved overall post-pandemic.
Conclusions:
- The COVID-19 pandemic influenced pediatric unintentional injury patterns, affecting injury types, demographics, and severity.
- Continuous epidemiological surveillance is vital for refining age-specific prevention strategies.
- Adapting clinical resource allocation is necessary to address evolving pediatric injury care needs.
Objective:
This study aimed to analyze the epidemiological characteristics and trends of hospitalizations for unintentional injuries (UI) among children and adolescents (≤18 years) before (2015-2019) and after (2020-2024) the COVID-19 pandemic.
Methods:
A retrospective review was conducted on 51,591 UI-related hospital admissions from our university-affiliated children's hospital. Patients were categorized into five age groups: infants (<1 year), toddlers (1-3 years), preschool-age (4-6 years), school-age (7-12 years), and adolescents (13-18 years). Data were analyzed across the two defined periods.
Results:
The total number of UI hospitalizations decreased in Post-COVID compared to pre-COVID. Marked reductions were observed particularly in 2020 and 2022, with a gradual upward trend emerging from 2023 onward-patterns consistent with the evolving impacts of the pandemic. The majority of patients were male and from rural areas throughout the study. However, an increasing yearly trend was observed in the proportion of female patients and those from urban areas after the pandemic. Toddlers consistently had the highest hospitalization rate. A shift in age distribution was noted, with a decreased proportion of cases among infants and toddlers and an increased proportion among school-age children and adolescents post-COVID. Fall/slip were the most common injury mechanism across all ages. Compared with the pre-pandemic period, the proportion of foreign body has decreased significantly in infants, whereas the rate of accidental poisoning has risen markedly among adolescents. Traffic accidents were consistently associated with the highest intensive care unit (ICU) admission rate, the highest readmission rate, and the highest medical costs, yet the lowest rate of recovered/improved. The pattern of body injuries varied with age, with head injuries decreasing and injuries to the extremities, abdomen, and pelvis becoming more common in older age groups. Clinical outcomes improved, with a lower rate of critical illness and higher rates of ICU admission, surgical intervention, and clinical recovered/improved post-COVID.
Conclusion:
This study delineates the evolving landscape of pediatric UI before and after the COVID-19 pandemic. While the fundamental causes of injury remain, their proportions and severities have shifted, influenced by changes in children's living environments and activities. These results underscore the importance of continuous epidemiological surveillance to inform and refine effective, age-specific prevention strategies and to optimize clinical resource allocation for pediatric injury care.
