ABSTRACT
Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.
ABSTRACT
Background: During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders, and were potentially unsupervised, increasing their risk for unintentional injury. The objective of this study was to investigate how these events impacted the incidence of burn injuries in children. Methods: A total of 9 Level I pediatric trauma centers participated in a retrospective study evaluating children <18 years of age with traumatic injuries as defined by the National Trauma Data Bank were included. Patients with burn injuries were defined by ICD10 Diagnosis and/or External Cause of Injury Codes. Historical controls from March-September 2019 (“Control” cohort) were compared to patients injured after the implementation of the Stay-at-Home Orders from March through September 2020 (“COVID” cohort). Results: A total of 13,177 pediatric trauma patients were included, of which 987 patients had burn injuries. The total number of children with burn injury increased by 48.6% in 2020, compared to 2019 (COVID cohort 590 patients vs. Control cohort 397 patients;p-value < 0.001), of which 94% was explained by unintentional injury. School aged children accounted for the largest difference in burn injuries between the two cohorts [Table 1]. The average number of burn-injured patients admitted per month increased over time and the difference between 2019 and 2020 peaked in July [Figure 1]. Compared to 2019, the proportion of children sustaining flame burns increased significantly in 2020 (Control 19.1% vs. COVID 26.1%, p=0.0014). Conclusion: During the COVID-19 pandemic, families experienced unprecedented increased social and financial pressure, and children were out of school for extended periods of time. This time period coincided with a considerable increase in burn injuries. The disproportionate increase in burn injuries in July may reflect the cancellation of professional firework shows across the nation and an increase in amateur pyrotechnicians experimenting with their own fireworks. The onset of the COVID pandemic introduced an extraordinary set of events with unclear consequences. (Table Presented).
ABSTRACT
Background: In response to the COVID-19 pandemic, local and regional Stay-at-Home orders (SHO) were implemented. Families experienced job loss, financial strain, and children were unable to attend school. It is unclear how this combination of events and social stress affected the welfare of children and rates of pediatric injury nationwide. We hypothesized that the rate of non-accidental trauma (NAT) would increase during the SHO as children did not have access to mandatory reporters, such as schoolteachers and primary care physicians. Methods: A multi-center, retrospective study was conducted evaluating patients <18 years old with traumatic injuries as defined by National Trauma Data Bank. Patients with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT were included. “Historical” controls from an averaged period of March-September 2016-2019 were compared to patients injured after the implementation of SHO through September 2020 (“COVID” cohort). SHO were defined at the state level for each site. An interrupted time series analysis was utilized to evaluate the effect of the implementation of SHO. Results: A total of 9 Level I pediatric trauma centers were included, contributing 39,331 pediatric trauma patients, of which 2,064 met criteria for NAT. During the initial SHO, the rate of NAT dropped below what was expected based on the historical trends, however, thereafter the rate increased above the expected rates of NAT [Figure 1]. The COVID cohort experienced a significant increase in the proportion of NAT patients age >5 years (Historical 36 patients [13.5%] vs. COVID 103 patients [30.8%], p<0.001). Ultimately, 2020 experienced an increased cumulative burden of NAT cases as reported to institutional trauma registries when compared to the Historical cohort [Figure 2]. Conclusion: The COVID-19 pandemic affected the presentation of children with NAT to the hospital. For school-aged children sequestered at home by the pandemic, increased NAT may reflect the absence of normal safeguards provided by the educational system, potentially leaving a vulnerable population at risk. Particularly in times of public health crisis, maintaining systems of protection for children remains essential.