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

Holly R Hanson; Margaret Formica; Danielle Laraque-Arena; Mark R Zonfrillo; Puja Desai; Joseph O O'Neil; Purnima Unni; Estell Lenita Johnson; Patricia Cobb; Maneesha Agarwal; Kristen Beckworth; Stephanie Schroter; Stephen Strotmeyer; Katie A Donnelly; Leah K Middelberg; Amber M Morse; James Dodington; Richard F Latuska; Brit Anderson; Karla A Lawson; Michael Valente; Michael N Levas; Andrew Waititu Kiragu; Kathy Monroe; Stephanie M Ruest; Lois K Lee; Tanya Charyk Stewart; Megan M Attridge; Maya Haasz; Mubeen Jafri; Alicia McIntire; Steven C Rogers; Neil G Uspal; Ashley Blanchard; Max D Hazeltine; Teresa Riech; Charles Jennissen; Lynn Model; Quinney Fu; Lindsay D Clukies; David Juang; Michelle T Ruda; Jose M Prince; Stephanie Chao; Brian K Yorkgitis; Wendy J Pomerantz

doi:10.1186/s40621-023-00476-z

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

Inj Epidemiol. 2023 Dec 13;10(1):66. doi: 10.1186/s40621-023-00476-z.

Authors

Holly R Hanson^{1

2}, Margaret Formica³, Danielle Laraque-Arena^{4

5}, Mark R Zonfrillo^{6

7}, Puja Desai⁸, Joseph O O'Neil⁹, Purnima Unni¹⁰, Estell Lenita Johnson¹¹, Patricia Cobb¹², Maneesha Agarwal¹³, Kristen Beckworth¹⁴, Stephanie Schroter¹⁵, Stephen Strotmeyer^{16

17}, Katie A Donnelly¹⁸, Leah K Middelberg¹⁹, Amber M Morse²⁰, James Dodington²¹, Richard F Latuska²², Brit Anderson²³, Karla A Lawson²⁴, Michael Valente²⁵, Michael N Levas²⁶, Andrew Waititu Kiragu²⁷, Kathy Monroe²⁸, Stephanie M Ruest^{6

7}, Lois K Lee²⁹, Tanya Charyk Stewart³⁰, Megan M Attridge³¹, Maya Haasz³², Mubeen Jafri³³, Alicia McIntire³⁴, Steven C Rogers³⁵, Neil G Uspal³⁶, Ashley Blanchard³⁷, Max D Hazeltine³⁸, Teresa Riech³⁹, Charles Jennissen^{40

41}, Lynn Model⁴², Quinney Fu⁴³, Lindsay D Clukies⁴⁴, David Juang⁴⁵, Michelle T Ruda⁴⁶, Jose M Prince⁴⁷, Stephanie Chao⁴⁸, Brian K Yorkgitis⁴⁹, Wendy J Pomerantz⁵⁰

Affiliations

¹ Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. holly.hanson@cchmc.org.
² Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. holly.hanson@cchmc.org.
³ Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
⁴ New York Academy of Medicine, New York, New York, USA.
⁵ Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, Syracuse, NY, USA.
⁶ Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
⁷ Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
⁸ Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA.
⁹ Department of Pediatrics, Indiana University, Indianapolis, IN, USA.
¹⁰ Department of Pediatric Trauma, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
¹¹ Department of Epidemiology, School of Public Health, Injury Free Coalition for Kids, Columbia University, New York City, NY, USA.
¹² Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹³ Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
¹⁴ Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA.
¹⁵ Department of Pediatric Emergency Medicine, University of California, Rady Children's Hospital San Diego, San Diego, CA, USA.
¹⁶ Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁷ Allegheny County Health Department, Pittsburgh, PA, USA.
¹⁸ Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA.
¹⁹ Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
²⁰ Division of Pediatric Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA.
²¹ Yale School of Medicine, New Haven, CT, USA.
²² Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²³ Department of Pediatric Emergency Medicine, Norton Children's Hospital, Louisville, KY, USA.
²⁴ Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, Austin, TX, USA.
²⁵ Department of Pediatric Emergency Medicine, Children's Health Orange County, Orange, CA, USA.
²⁶ Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁷ Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA.
²⁸ Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
²⁹ Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
³⁰ Department of Paediatrics, University of Western Ontario and London Health Sciences Centre, London, ON, Canada.
³¹ Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
³² Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
³³ Department of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA.
³⁴ Department of Pediatric Surgery, Randall Children's Hospital at Emanuel Legacy, Portland, OR, USA.
³⁵ Department of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, CT, USA.
³⁶ Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
³⁷ Department of Emergency Medicine, Columbia University Medical Center, New York City, NY, USA.
³⁸ Department of Surgery, UMass Chan Medical School, Worcester, MA, USA.
³⁹ Department of Pediatric Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA.
⁴⁰ Department of Pediatrics, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA.
⁴¹ Department of Emergency Medicine, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA.
⁴² Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
⁴³ Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.
⁴⁴ Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA.
⁴⁵ Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
⁴⁶ Department of Pediatrics, Children's Memorial Hermann Hospital, UTHealth Houston, Houston, TX, USA.
⁴⁷ Department of Pediatric Surgery, Northwell Health, New Hyde Park, NY, USA.
⁴⁸ Division of Pediatric Surgery, Stanford School of Medicine, Palo Alto, CA, USA.
⁴⁹ Department of Surgery, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA.
⁵⁰ Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

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.

Keywords: Disparities; Emergency department; Injuries; Injury prevention; Pandemic; Pediatrics.

Abstract

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