A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic

• Type of Material: Article
• Authors: Holly R. Hanson, Vanderbilt University; Margaret Formica, SUNY Upstate Medical University; Danielle Laraque-Arena, Columbia University; Mark R. Zonfrillo, Brown University; Puja Desai, Washington University, St. Louis; Joseph O. O'Neil, Indiana University; Purnima Unni, Vanderbilt University; Estell Lenita Johnson, Columbia University; Patricia Cobb, Cincinnati Children's Hospital Medical Center; Maneesha Agarwal, Emory University; Kristen Beckworth, Texas Children's Hospital; Stephanie Schroter, University of California, San Diego; Stephen Strotmeyer, University of Pittsburgh; Katie A. Donnelly, Children's National Hospital; Leah K. Middelberg, Nationwide Children's Hospital; Amber M. Morse, University of Arkansas, Little Rock; James Dodington, Yale University; Richard F. Latuska, Children's Hospital of Philadelphia; Brit Anderson, Norton Children's Hospital; Karla A. Lawson, Dell Children's Medical Center of Central Texas; Michael Valente, Children's Health Orange County; Michael N. Levas, Medical College of Wisconsin; Andrew Waititu Kiragu, University of Minnesota, Minneapolis; Kathy Monroe, University of Alabama, Birmingham; Stephanie M. Ruest, Brown University; Lois K. Lee, Boston Children's Hospital; Tanya Charyk Stewart, University of Western Ontario; Megan M. Attridge, Ann and Robert H. Lurie Children's Hospital of Chicago; Maya Haasz, University of Colorado, Aurora; Mubeen Jafri, Oregon Health and Science University; Alicia McIntire, Randall Children's Hospital at Emanuel Legacy; Steven C. Rogers, University of Connecticut, Hartford; Neil G. Uspal, University of Washington, Seattle; Ashley Blanchard, Columbia University; Max D. Hazeltine, University of Massachusetts, Worcester; Teresa Riech, OSF Saint Francis Medical Center, Peoria; Charles Jennissen, University of Iowa, Iowa City; Lynn Model, Maimonides Medical Center; Quinney Fu, Phoenix Children's Hospital; Lindsay D. Clukies, Washington University, St. Louis; David Juang, Children's Mercy Hospital; Michelle T. Ruda, Children's Memorial Hermann Hospital; Jose M. Prince, Northwell Health; Stephanie Chao, Stanford University; Brian K. Yorkgitis, University of Florida, Jacksonville; Wendy J. Pomerantz, University of Cincinnati
• Language: English
• Date: 2023-12-13
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1186/s40621-023-00476-z
• Title of Journal or Parent Work: Injury Epidemiology
• Volume: 10
• Start Page: 66
• Grant/Funding Information: Dr. Wendy J. Pomerantz received a grant from the Division of Emergency Medicine at Cincinnati Children’s Hospital Medical Center to support the Data Coordinating Center. The other authors received no additional funding.
• Keywords: Injuries; Pandemic; Disparities; Emergency department; Injury prevention; Pediatrics
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background Injuries, the leading cause of death in children 1–17 years old, are often preventable. Injury patterns are impacted by changes in the child’s environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. Methods This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00–T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. Results The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (− 4.9%) and overexertion (− 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. Conclusions The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.