Multi-day delay to care identified in pediatric trauma cases during COVID-19

Abstract

This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado. Patients were excluded for treatment at another institution ( n = 148), no fracture noted in clinic ( n = 18), or other ( n = 13). Data were retrospectively collected from the remaining 1838 patients regarding demographics, fracture injury, mechanism, and treatment. Odds ratios (ORs) were calculated for each variable during COVID-19 relative to prior years. The number of fractures during 2020 decreased by 26% relative to 2019 and 23% to 2018. A larger proportion of patients experienced at least a 5-day delay to definitive treatment [OR: 1.55, confidence interval (CI): 1.23–1.96, P = 0.0002]. Rates of non-accidental trauma (NAT) increased non-significantly (OR: 2.67, CI: 0.86–8.32, P = 0.0900) during 2020 (1.2%) relative to 2018 (0.6%) and 2019 (0.3%). Fractures occurring at home increased to 79.9% (OR: 6.44, CI: 5.04–8.22, P < 0.0001). Despite less overall trauma during shelter-in-place orders, greater fracture numbers were seen among younger children and severe fractures were likely among older children. Patients may hesitate to seek care during 2020. Rates of NAT doubled during 2020. As communities prepare for future waves, treatment centers should warn against common fracture mechanisms and raise awareness of NAT.

Kids gone wild – Alcohol use and patient characteristics in pediatric trauma during the coronavirus disease 2019 pandemic

“…8,[29][30][31][32] However, it is troubling that some centers noted concerning findings such as higher acuity, increased hospital and intensive care admission rates, and potentially delayed presentations for common serious illnesses such as appendicitis and fractures. 8,32,33 The effect of COVID-19 on the field of pediatric surgery has been profound -requiring many changes to maximize safety while maintaining the ability to do high-acuity procedures. 34 The reported effects of the pandemic on pediatric trauma have been variable.…”

“…In Texas, Sanford et al 36 found overall decreased pediatric trauma, but with increased burns and penetrating injuries. A study by Shaw et al 33 from Colorado, describes an overall decrease in pediatric fractures but with increased fractures in younger children, more severe fractures in older children, and a significant increase in delayed presentation for treatment.…”

“…Studies from Colorado and Michigan demonstrated increases in the incidence of nonaccidental trauma and abuse, while a similar study from a pediatric trauma center in New York demonstrated rates to be unchanged. 10,33,35 Multicenter and multistate studies have not demonstrated an overall increase in rates of non-accidental trauma in children. 11 However, Lewit et al 45 did demonstrate that African American children experienced an increased rate of non-accidental trauma, although the overall for all children rate remained the same.…”

Fractures in Children Due to Firearm Activity

“…The data from 1993 through 2020 was downloaded from the ICPSR website; however, due to changes in injury patterns associated with the COVID pandemic, those data from the year 2020 were excluded [ 27 , 28 , 29 , 30 , 31 , 32 ], including firearm injuries [ 33 , 34 , 35 ]. The data includes age, sex, race, type of firearm, the perpetrator of the injury (e.g., self, stranger, etc.…”

COVID-19 and delay to care in pediatric trauma

“…We would like to share ideas on ‘Multi-day delay to care identified in pediatric trauma cases during COVID-19’ [1]. Shaw et al ., [1] found an increasing nonaccidental trauma in 2020 compared to the previous year. In fact, the impact of COVID-19 is widely reported.…”