Pre-Pandemic Trends Re-emerge in Pediatric Pedestrian Injury

To quantify changes in the rates and demographic distribution of pediatric pedestrian injuries before and after the COVID-19 pandemic.

We used interrupted time series analysis to characterize pre- and post-2020 trends in volume, age, race/ethnicity, day/night timing, and severity of pedestrian injuries among children aged ≤15 seen in academic pediatric emergency departments within the Pediatric Health Information System (2016-2023).

A total of 19,958 visits for pedestrian injury were identified. Annual volumes fell from a mean of 2,743 (CI 95% = 2,499, 2,988) to 1,789 in 2020, or an estimated 897 fewer than expected (95% CI = 612, 1180), then increased by 259 visits/year (95% CI = 200, 317) to 2,570 by 2023. This pattern was primarily driven by school-aged adolescent children (aged 10-15), whose visit volumes fell from 1,331 in 2016-2019 to 765 in 2020, then rebounded to 1,334 by 2023. The proportion of non-White children fell from 73.4% in 2016-2019 to 66.8% in 2020, then increased by 2.2%/year through 2023 to 72.9%. Daytime presentations similarly fell from 73.7% to 69.6% in 2020, then rebounded to 72.5% by 2023. No pandemic-associated changes were seen in mean Child Opportunity Index or income.

The COVID-19 pandemic was associated with large but temporary decreases in overall pediatric pedestrian trauma volumes and percent non-White patients, especially during the day and among school-aged children. These patterns suggest that routine daily traffic exposure may contribute differently to pedestrian risk across age groups and racial/ethnic categories with potential implications for targeted safety interventions.