Pediatric Trauma and the COVID-19 Pandemic: A 12-Year Comparison in a Level-1 Trauma Center.
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ABSTRACT: Background
The effect of COVID-19 on pediatric trauma rates is still largely under investigation. With the potential need to reallocate human and financial resources at this challenging time, it will be useful to have detailed descriptions of the rates of pediatric trauma and understanding of how the pandemic affects these rates.Questions/purposes
We sought to describe the effect of the COVID-19 pandemic on the number of acute pediatric trauma admissions and procedures performed in a level-I trauma center in Cork University Hospital, Ireland.Methods
We compared the number of acute traumatic pediatric admissions and procedures that occurred during the first 4 weeks of a nationwide lockdown due to COVID-19 with that of the same 4-week period in each of the preceding 11 years. Seasonal variables were measured and controlled for using multivariate regression analysis.Results
A total of 545 pediatric patients (under 16 years of age) were included. Over 12 years, the lowest number of acute traumatic pediatric admissions and procedures was recorded during the 2020 pandemic. There was a significant correlation between the number of school days and the number of acute traumatic admissions, as well as the procedures performed. The relationship between the number of school days and the number of trauma procedures was evident even when controlling for confounder variables of seasonal variation.Conclusion
The COVID-19 pandemic significantly reduced the number of acute traumatic pediatric admissions and procedures performed in our level-I trauma center, likely because of a reduction in school days. With the reopening of schools, playgrounds, and sporting events, an increase in pediatric trauma admissions is anticipated. The results of this study can help prepare institutions and regulatory bodies to plan appropriately for this new phase.
SUBMITTER: Sheridan GA
PROVIDER: S-EPMC7537984 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:To evaluate the 15-year trend in the use of computed tomography (CT) in hospitalized pediatric trauma patients admitted to Harborview Medical Center (HMC) from 1996 to 2010.This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board. The requirement for informed consent was waived. The HMC trauma registry was linked to the billing department data, and patient and injury-related characteristics were extracted, in addition to type and frequency of CT procedures. Patients discharged from the emergency department and patients hospitalized for less than 24 hours were not included in this study. Patients were classified into three categories according to age: 0-14 years, 15-18 years, and 19-54 years (reference group). Multivariate negative binomial regression was used to compare CT usage among different age groups by adjusting for patient sex, race and/or ethnicity, insurance status, mechanism of injury, injury severity, final disposition (dead vs alive), and year of admission. The trend for CT use in children and teenagers was also evaluated.A total of 64 425 trauma patients 0-54 years of age were admitted during the study period. Compared with CT usage in adults 19-54 years old, usage in children up to 15 years of age was significantly lower for spine (incidence rate ratio [IRR], 0.89; 95% confidence interval [CI]: 0.85, 0.92), maxillofacial (IRR, 0.89; 95% CI: 0.81, 0.97), and thoracic (IRR, 0.91; 95% CI: 0.84, 0.99) CT. Increased use of head CT was observed in children up to 15 years old (IRR, 1.09; 95% CI: 1.05, 1.13) and 15-18 years old (IRR, 1.08; 95% CI: 1.04, 1.13). From 2008 to 2010, usage rates in children up to 15 years old and 15-18 years old was relatively unchanged or slightly decreased for almost all CT types.A decreasing or unchanged trend was observed in CT usage in hospitalized pediatric trauma patients in recent years. © RSNA, 2013.
| S-EPMC3632809 | biostudies-other
Project description:Background The coronavirus disease 19 (COVID-19) pandemic is reported to have changed injury patterns, prevalence, and outcomes across multiple institutions in the United States. Interpretation of aggregate data is difficult because injury patterns vary between urban and rural hospitals and the implementation of locoregional public health policies and guidelines in response to COVID-19 differed. To prepare our trauma system for future societal shutdowns, we compared injury patterns and outcomes of injured children and adolescents at a single pediatric trauma center before and during the first two years of the COVID-19 pandemic. Material and Methods We abstracted demographic, injury, and outcome data for injured children and adolescents (age <15 years) who required admission using our hospital trauma registry and the electronic medical record. We compared differences prior to and during the COVID-19 pandemic using univariate analysis. To address confounding variables, we also analyzed in-hospital mortality using a multivariable regression. Results We observed an increase in the number of injured children requiring admission during the first year of the COVID-19 pandemic compared to the pre-pandemic era. Among injury types sustained, we observed an increase in firearm and non-firearm related penetrating injuries (p < 0.001) during the first year, but not the second year, of the COVID-19 pandemic. Controlling for several confounding variables, we also observed an increase in in-hospital mortality (p = 0.04) during the first year of the COVID-19 pandemic. Conclusions The psychosocial and socioeconomic burden of the COVID-19 pandemic may have contributed to the rise in penetrating injuries and the odds of in-hospital mortality among a cohort of children and adolescents who were admitted to our hospital following injury. This data may be used to prepare our trauma system for future societal shutdowns through data informed resource utilization.
| S-EPMC10285201 | biostudies-literature
Project description:Background/objectiveThe COVID-19 pandemic has had a profound impact on the global delivery of health care. Recent data suggest a possible impact of the pandemic on patterns of neurotrauma. The aim was to assess the impact of the pandemic on the incidence of neurotrauma, with a focus on cranial gunshot wounds (cGSWs) at a large Midwestern level 1 trauma center.MethodsWe conducted a retrospective review of our trauma registry from March through September 2020 and compared it to the same months in 2019. Odds ratios were utilized to assess for differences in patient demographics, injury characteristics, rates of neurotrauma, and rates of cGSWs.ResultsA total of 1188 patients presented with neurotrauma, 558 in 2019 and 630 in 2020. The majority of patients were male (71.33% in 2019; 68.57% in 2020) and Caucasian (78.67% in 2019; 75.4% in 2020). Patients presented with cGSWs more frequently in 2020 (n = 49, 7.78%) than in 2019 (n = 25, 4.48%). The odds of suffering a cGSW in 2020 was 73.6% higher than those in 2019 (95% confidence interval = [1.0871, 2.7722]; P = 0.0209). The etiology of such injury was most commonly assault (n = 16, 21.62% in 2019; n = 34, 45.95% in 2020), followed by self-inflicted injury (n = 4, 5.41% in 2019; 12, 16.22% in 2020).ConclusionsDespite the government-mandated shutdown, we observed an increase in the number of neurotrauma cases in 2020. There was a significant increase in the incidence cGSWs in 2020, with an increase in assaults and self-inflicted injuries. Further investigation into socioeconomic factors for the observed increase in cGSWs is warranted.
| S-EPMC9085351 | biostudies-literature
Project description:Background and aimsThe COVID-19 pandemic has reshaped the epidemiology of various clinical conditions, including trauma which is closely tied to social policies. This study examines and compares the characteristics of trauma mortality patients, and their initial prognostic trauma scores, in the pre-pandemic and pandemic periods.MethodsWe conducted a retrospective observational study involving patients who passed away at a level 1 trauma center from July 23, 2018, to February 19, 2020 (prepandemic), and from February 20, 2020, to September 22, 2021 (pandemic). A subgroup analysis that matched 12 of the same months of the year in the two periods was also done. Patients who arrived deceased or passed away immediately upon arrival were excluded from data analysis. We collected and analyzed demographic and clinical data, employing the Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and ISS (TRISS) to compare initial prognoses.ResultsOur study encompassed 1128 patients, with 529 in the prepandemic group and 599 in the pandemic group. Demographic characteristics showed no significant differences in the number of patients in the two periods. Motor vehicle accidents remained the predominant injury mechanism in both periods. While the mean ISS increased insignificantly (22.80 vs. 22.91, p = 0.902), the mean RTS decreased (6.32 vs. 5.82), and TRISS increased (23.97% vs. 28.93%) during the pandemic (p < 0.05). Hospital length of stay decreased in the pandemic period (15.57 vs. 12.54 days, p < 0.05). Subgroup analysis revealed increased ISS, decreased RTS, and increased TRISS during the pandemic (p < 0.05).ConclusionIn conclusion, while overall demographics and injury mechanisms remained virtually unchanged, trauma patients during the pandemic displayed worse estimated clinical prognoses, particularly in physiological trauma scores. The heightened mortality rate was attributed to poorer clinical conditions of patients.
| S-EPMC10864731 | biostudies-literature
Project description:ObjectivesEvaluate the effect of easing "shelter-in-place" restrictions and coronavirus-2019 (COVID-19) cases on orthopaedic trauma encounters (OTEs) at a community level II trauma center.MethodsA retrospective analysis was conducted of OTEs from March-June of 2016 to 2020. Injuries were classified by high or low severity. Admission and surgical intervention rates were also compared year to year. Data were statistically analyzed and compared with external data for traffic counts near the hospital and COVID-19 cases in Michigan as well as a timeline for enacting and easing of shelter-in-place orders in the state of Michigan.ResultsThere was no difference in the number of OTEs May to June, 2020 compared with the average of those same months 2016 to 2019. March to June, 2020 showed no change in proportion of injury severity, admissions, or surgical interventions when compared with the average of March-June, 2016 to 2019, although the overall quantity of each was decreased in March and April. A significant negative correlation was found between the daily number of COVID-19 cases in Michigan and OTEs.ConclusionsThe quantity of OTEs normalized to pre-COVID-19 levels in May and June of 2020 compared with 2016 to 2019 despite a previously documented 45.1% drop in March and April. A negative correlation was noted between the number of reported Michigan COVID-19 cases and volume of OTEs. There were no significant changes noted to admission rates or rates of surgical intervention on OTEs throughout the time period studied.
| S-EPMC8568387 | biostudies-literature
Project description:IntroductionThe first COVID-19 cases occurred in the US in January of 2020, leading to the implementation of shelter in place. This study seeks to define the impact of shelter in place on the epidemiology of pediatric trauma.MethodsWe examined pediatric trauma admissions at 5 Level 1 and 1 Level 2 US pediatric trauma centers between January 1 and June 30, 2017-2020. Demographic and injury data were compared between pre- and post-shelter in place patient cohorts.ResultsA total of 8772 pediatric trauma activations were reviewed. There was a 13% decrease in trauma volume in 2020, with a nadir at 16 days following implementation of shelter in place. Injury severity scores were higher in the post-shelter in place cohort. The incidence of nonmotorized vehicle accidents and gunshot wounds increased in the post-shelter in place cohort.ConclusionWe found an overall decrease in pediatric trauma volume following shelter in place. However, injuries tended to be more severe. Our findings help inform targeted injury prevention campaigns during future pandemics.
| S-EPMC8275016 | biostudies-literature
Project description:PurposeMost children with intra-abdominal injuries can be managed non-operatively. However, in Europe, there are many different healthcare systems for the treatment of pediatric trauma patients. Therefore, the aim of this study was to describe the management strategies and outcomes of all pediatric patients with blunt intra-abdominal injuries in our unique dedicated pediatric trauma center with a pediatric trauma surgeon.MethodsWe performed a retrospective, single-center, cohort study to investigate the management of pediatric patients with blunt abdominal trauma. From the National Trauma Registration database, we retrospectively identified pediatric (≤ 18 years) patients with blunt abdominal injuries admitted to the UMCU from January 2012 till January 2018.ResultsA total of 121 pediatric patients were included in the study. The median [interquartile range (IQR)] age of patients was 12 (8-16) years, and the median ISS was 16 (9-25). High-grade liver injuries were found in 12 patients. Three patients had a pancreas injury grade V. Furthermore, 2 (1.6%) patients had urethra injuries and 10 (8.2%) hollow viscus injuries were found. Eighteen (14.9%) patients required a laparotomy and 4 (3.3%) patients underwent angiographic embolization. In 6 (5.0%) patients, complications were found and in 4 (3.3%) children intervention was needed for their complication. No mortality was seen in patients treated non-operatively. One patient died in the operative management group.ConclusionsIn conclusion, it is safe to treat most children with blunt abdominal injuries non-operatively if monitoring is adequate. These decisions should be made by the clinicians operating on these children, who should be an integral part of the entire group of treating physicians. Surgical interventions are only needed in case of hemodynamic instability or specific injuries such as bowel perforation.
| S-EPMC8476366 | biostudies-literature
Project description:PurposePrevious literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.MethodsInstitutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.ResultsCompared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.ConclusionDuring the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.Level of evidenceLevel III.
| S-EPMC10285363 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic disrupted social, political, and economic life across the world, shining a light on the vulnerability of many communities. The objective of this study was to assess injury patterns before and after implementation of stay-at-home orders (SHOs) between White children and children of color and across varying levels of vulnerability based upon children's home residence.MethodsA multi-institutional retrospective study was conducted evaluating patients < 18 years with traumatic injuries. A "Control" cohort from an averaged March-September 2016-2019 time period was compared to patients injured after SHO initiation-September 2020 ("COVID" cohort). Interactions between race/ethnicity or social vulnerability index (SVI), a marker of neighborhood vulnerability and socioeconomic status, and the COVID-19 timeframe with regard to the outcomes of interest were assessed using likelihood ratio Chi-square tests. Differences in injury intent, type, and mechanism were then stratified and explored by race/ethnicity and SVI separately.ResultsA total of 47,385 patients met study inclusion. Significant interactions existed between race/ethnicity and the COVID-19 SHO period for intent (p < 0.001) and mechanism of injury (p < 0.001). There was also significant interaction between SVI and the COVID-19 SHO period for mechanism of injury (p = 0.01). Children of color experienced a significant increase in intentional (COVID 16.4% vs. Control 13.7%, p = 0.03) and firearm (COVID 9.0% vs. Control 5.2%, p < 0.001) injuries, but no change was seen among White children. Children from the most vulnerable neighborhoods suffered an increase in firearm injuries (COVID 11.1% vs. Control 6.1%, p = 0.001) with children from the least vulnerable neighborhoods having no change. All-terrain vehicle (ATV) and bicycle crashes increased for children of color (COVID 2.0% vs. Control 1.1%, p = 0.04 for ATV; COVID 6.7% vs. Control 4.8%, p = 0.02 for bicycle) and White children (COVID 9.6% vs. Control 6.2%, p < 0.001 for ATV; COVID 8.8% vs. Control 5.8%, p < 0.001 for bicycle).ConclusionsIn contrast to White children and children from neighborhoods of lower vulnerability, children of color and children living in higher vulnerability neighborhoods experienced an increase in intentional and firearm-related injuries during the COVID-19 pandemic. Understanding inequities in trauma burden during times of stress is critical to directing resources and targeting intervention strategies.
| S-EPMC10683076 | biostudies-literature
Project description:Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. The present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008-January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. The primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m2, 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and all-terrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. The intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, p=0.46), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, p=0.80), and time from injury to repair (4.3 vs. 60.5 h, p=0.23) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. The complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. The present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional protocol which now includes recommendations regarding length of catheterization after traumatic bladder rupture. By providing specific guidelines for initial follow-up cystogram and foley removal, we hope to decrease patient morbidity from prolonged catheterization. Further study will seek to allow multidisciplinary trauma teams to standardize management, streamline care, and minimize complications for patients presenting with traumatic bladder injuries.
| S-EPMC6930775 | biostudies-literature