Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. This classification system will serve as a foundation to guide ongoing research efforts and standardize communication in the clinical setting.

Introduction The goal of early-onset scoliosis (EOS) treatment is to improve health-related quality of life (HRQoL) for patients and to reduce the burden on their parents or caregivers. The purpose of this study is to develop and finalize the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24), and examine the validity, reliability, and responsiveness of the EOSQ-24 in measuring patients’ HRQoL, the burden on their caregivers, and the burden on their caregiver’s finances. The study also established aged-matched normative values for the EOSQ-24. Methods The EOSQ-24 was administered to caregivers of male and female patients aged 0 to 18 years with EOS. Patients with EOS are diagnosed before 10 years of age. Criterion validity was investigated by measuring agreement between its scores and pulmonary function testing. Construct validity was established by comparing values across different etiology groups using the known-group method, and measuring internal consistency reliability. Content validity was confirmed by reviewing caregiver and health provider ratings for the relativity and clarity of the EOSQ-24 questions. Test-retest reliability was examined through intraclass correlation coefficients. Responsiveness of the EOSQ-24 before and after surgical interventions was also investigated. Age-matched, healthy patients, without spinal deformity, were enrolled to establish normative EOSQ-24 values. Results The pulmonary function subdomain score in the EOSQ-24 was positively correlated with pulmonary function testing values, establishing criterion validity. The EOSQ-24 scores for neuromuscular patients were significantly decreased compared with idiopathic or congenital/structural patients, demonstrating known-group validity. Internal consistency reliability of patients’ HRQoL was excellent (0.92), but Family Burden was questionable (0.64) indicating that Parental Burden and Financial Burden should be in separate domains. All 24 EOSQ items were rated as essential and clear, confirming content validity. All EOSQ-24 domains demonstrated good to excellent agreement (0.68 to 0.98) between test and retest scores. Neuromuscular patients improved their HRQoL postoperatively, whereas idiopathic patients worsened their HRQoL postoperatively, indicating the ability of the instrument to respond to different trajectories of HRQoL according to etiology in patients with EOS. Discussion The developed and finalized EOSQ-24 is a valid, reliable, and responsive instrument that is able to serve as a patient-reported outcome measure evaluating health status for patients with EOS and burden of their caregivers. This instrument will be able to serve as an outcome measure for future research including clinical trials evaluating the effectiveness of various treatments. In addition, the EOSQ-24 allows assessment of patients’ HRQoL, and the burden on their caregivers relative to age-matched healthy peers. Level of Evidence Level II—diagnostic study with consecutive patients enrolled in national registries.

Surgical site infection rates were significantly higher following procedures in patients with non-idiopathic scoliosis (p < 0.001). Lengthening procedures had the lowest rate of surgical site infection among patients with early onset scoliosis who had undergone instrumentation with growing constructs. Gram-negative pathogens were common and were most common following procedures in patients with non-idiopathic scoliosis. These findings suggest a role for targeted perioperative antibiotic prophylaxis to prevent surgical site infection following pediatric scoliosis instrumentation procedures.

Background: Fractures are a common pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life that could impact the incidence of pediatric fractures. The purpose of this study was to compare the incidence of pediatric fractures in the United States during the COVID-19 pandemic to previous seasonally adjusted fracture incidence rates using the National Electronic Injury Surveillance System (NEISS) database and the American Community Survey (ACS). Methods: The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0 to 17 y) patients. ACS population data allowed for the estimation of fracture incidence per 1000 person-years. Using a quasiexperimental interrupted time series design, Poisson regression models were constructed to test the overall and differential impact of COVID-19 on monthly fracture rate by age, sex, fracture site, injury location, and disposition. Results: Our sample consisted of 121,803 cases (mean age 9.6±4.6 y, 36.1% female) representing 2,959,421±372,337 fractures nationally. We identified a stable 27% decrease in fractures per month after February 2020 [risk difference (RD) per 1000 youth years=−2.3; 95% confidence interval: −2.98, −1.57]). We found significant effect modification by age, fracture site and injury location (P<0.05). The fracture incidence among children 5 years or older significantly decreased, as well as the incidence of fractures at school [RD=−0.96 (−1.09, −0.84)] and during sports [risk difference=−1.55 (−1.77, −1.32)]. There was also a trend toward a reduction in upper extremity fractures and fractures requiring admission. Conclusion: A nationally representative injury database demonstrated a 27% decline in monthly pediatric fractures during the COVID-19 pandemic that persisted into the latter half of 2020. These trends appeared most attributable to a reduction in fractures discharged home and upper extremity fractures among older children sustained at school and in sports. Our findings provide unique insight into the epidemiology of pediatric fractures and demonstrate a baseline need for musculoskeletal care among young children even in the setting of a national shutdown. Level of Evidence: Level II—retrospective prognostic study.

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