A Traumatic Pandemic: High Acuity Pediatric Trauma in the Covid-19 Era

Purpose of study COVID-19 has shifted the utilization of health care resources. Gaps remain in our understanding on how COVID-19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. We identified trends in the numbers and types of traumas presenting to a Level 1 Pediatric Trauma Center during the COVID-19 pandemic compared to prior years. Methods used We compared high acuity trauma visits (defined as traumas requiring admission, emergent surgical intervention or resulting in a fatality) presenting between January 1st and August 31st, 2020 to corresponding months in 2017-2019. We also evaluated the changes in mechanisms of injury during this time period. Data were analyzed using longitudinal time series analyses and t-tests. Summary of results Of 480 traumas presenting from January to August 2020, 227 (47.3%, 95%CI 42.7%-51.9%) were high acuity traumas. High acuity traumas declined significantly, as a state of emergency was declared, to a nadir of 16 in April 2020 (compared to the 2017-2019 mean of 38.3, p<0.001). As restrictions were lifted, high acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 (2017-2019 mean 35.7, p<0.001). High acuity traumas as a proportion of total Emergency Department visits were higher from March to August 2020 compared to prior years (figure 1). There were more visits for high acuity assaults and child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 compared to prior years, while visits for animal attacks remained stable Conclusions This analysis provides insight into how the COVID-19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues and further restrictions are debated. (Figure Presented).

Poisoning-related Pediatric Emergency Department Visits During the COVID-19 Pandemic at Three Mid-atlantic Hospitals

Background: The COVID-19 pandemic restructured daily life for children and adolescents in the United States and may have altered injury risk patterns. Studies exploring a possible increase in pediatric poisoning events are equivocal, with some indicating increased calls to poison control centers but no increased pediatric emergency visits for poisoning. This study aimed to i) compare the proportion of Emergency Department (ED) visits related to poisoning for pediatric patients before and during the COVID-19 pandemic, and ii) describe the acuity and patient characteristics associated with these visits. Methods: This is a repeated cross-sectional study of ED health records for patients 0 to 18 years of age at three hospitals in the mid-Atlantic region from 2018 through 2020. Poisoning-related visits were identified through International Classification of Disease (ICD-10) code or chief complaint. Relevant ICD-10 codes included T36-50 “Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances,” T51-65 “Toxic effect of substances chiefly nonmedical as to source,” and F10-19 “Mental and behavioral disorders due to psychoactive substance use.” Poisoning-related keywords in the chief complaint included “Poison/Poisoning,” “Ingestion,” “Overdose” and “Toxin.” These identifiers do not distinguish between intentional and unintentional poisonings. Patient demographic characteristics (age, sex, race, ethnicity), illness acuity, and disposition were reported. Data were analyzed using descriptive statistics and logistic regression on the odds of poisoning-related ED visits compared to ED visits for other reasons. Results: Of 147,736 total ED visits over the three-year study period, 2,478 (1.68%) were related to poisoning. There was a higher proportion of poisoning-related ED visits in 2020 (2.07% [721/34,835], 95%CI 1.92%-2.22%) compared to 2019 (1.49% [845/56,814], 95%CI 1.39%-1.59%) or 2018 (1.63% [912/56,087], 95% CI 1.52%-1.73%). The most common substances referenced in poisoning-related codes included cannabis (12.2%), non-opioid analgesics (7.7%), and alcohol (6.9%). The odds of poisoning-related ED visits increased for each increase in acuity along a 5-point scale (adjusted OR 2.18, 95%CI 1.90 - 2.50). The odds of poisoningrelated ED visits increased in 2020 compared to 2018 (OR 1.28, 95%CI 1.16 - 1.41) and to 2019 (OR 1.40, 95%CI 2.53 - 2.79), but results did not persist when adjusted for acuity and demographic characteristics. Teenagers and females displayed higher odds of poisoning-related ED visits (Table 1). Median acuity differed by year according to the Kruskal-Wallis test (X2(2) = 35, p<0.001). Post-hoc Dunn testing revealed median acuity differed in 2020 compared to 2018 (p<0.0001) or 2019 (p<0.0001), which suggests increased acuity of poison-related visits over time (Figure 1). Conclusion: Poisoning-related ED visits represented a higher proportion of total ED visits in 2020 compared to prior years;this was likely driven by the higher acuity of poisoning-related visits. Public health interventions should be targeted to decrease the frequency and acuity of pediatric poisoning events. Proportion of ED visits with a Triage Acuity Score of 1-2 for poisoning-related ED visits compared to ED visits for other reasons from 2018-2020. The number of poisoning-related ED visits with an acuity score of 1 or 2 was 432, 422, and 450 in 2018, 2019, and 2020, respectively. The number of other ED visits with an acuity score of 1 or 2 was 8,882, 9,489, and 6,656 in 2018, 2019, and 2020, respectively.