Effect of the COVID-19 Pandemic on Trauma Volume and Transport Time at a Level I Trauma Center

Introduction: Baystate Medical Center is the only Level I Trauma Center in Western, MA. The COVID-19 pandemic has had varying effects on Trauma Centers in regards to volume. Initial studies showed an increase in volume during the lockdown phase, but there has been no evidence of trends after lockdown. Method(s): Retrospective, review of trauma registry data pre- COVID (1/2016-2/2020) and during COVID-19 pandemic (3/2020-12/2021). Comparisons between time periods performed using T-Test. Result(s): Mean total traumas per month were significantly increased during the pandemic (191.3 v. 110.3 patients per month, p <0.001). Both blunt (174.2 v. 100.4, p <0.001) and penetrating (17.1 v 9.9, p <0.001) traumas increased during the COVID pandemic. There was a significant increase in both scene calls (105.0 v 73.8, p<0.001) and interfacility transfers (IFT) (42.7 v 36.0 P = 0.004) during the pandemic. There was no change in injury severity score (11.0 v 11.2, p = 0.498) during the pandemic. Ground interfacility transport times (34.13 min v 28.60 min, p = 0.036) increased significantly during COVID. Other transport times were not changed. Conclusion(s): During the COVID-19 pandemic, Baystate Medical Center saw a statistically significant increase in trauma volume across multiple dimensions that continued even after the end of the lockdown period. In addition, IFT ground transport times increased suggesting that patients were being transported from facilities farther away likely due to the strain on the regional health system from the pandemic.

Parental Distress during Separation from Their Critically Ill Child

BACKGROUND AND AIM: A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. Family-centered care (FCC) has been endorsed by major professional organizations. The SARS-CoV-2 pandemic has abruptly caused modifications in visitation policies of PICUs in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate elevated psychological distress compared to those who had limitless access to PICU. METHOD(S): Sociodemographics variables, levels of psychological distress, family functioning and ability to cope with stressful events were collected with an online survey in a group of caregivers (N=43) after their child hospitalization. A Pediatric Risk of Mortality-II (PRISM-II) score was calculated at child admission. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with limitless access (LA) to PICUs. All data were analyzed in the context of the Generalized Linear Model (GLZM). RESULT(S): Levels of depression, anxiety and the global severity index of psychological distress were significantly higher in NA with respect to LA (respectively LR chi2=9.885, p=0.001, LR chi2=5.54 p=0.08, LR chi2=6.928 p=0.008), correcting for gender, age, PRISM-II levels and personal ability to cope with stressful events. No significant effect of family functioning scores or other sociodemographic variables was found. CONCLUSION(S): Restrictions imposed to visitation policies in PICU during the pandemic negatively impacted on families' psychological well-being. A balance between safety of patients, families and health care professionals and meeting the needs of families is of utmost importance.

Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (Mis-C): Characteristics and Prognostic Value

BACKGROUND AND AIM: Following Covid-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described but data describing the LUS findings of MIS-C are limited. Aim of this retrospective observational study conducted between March, 1st, and December 31st, 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. Secondary objective is to evaluate concordance of LUS with Chest X-Ray (CXR). METHOD(S): Clinical and laboratory data were collected for all patients (age 0-18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, need for respiratory support and inotrope administration, hospital and PICU length of stay were considered as outcomes and evaluated in the different LUS patterns. Agreement between LUS and CXR evaluation was assessed with Cohen' k. RESULT(S): 38 children were enrolled;24 had a LUS examination upon admission. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. CONCLUSION(S): LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity;under this aspect, LUS can be used at admission to stratify risk of severe disease.

Changes in Bronchiolitis Picu Admissions in Italy: The Effect of Covid-19

BACKGROUND AND AIM: Bronchiolitis is the most common lower respiratory illness in young children, mostly caused by Respiratory Syncitial Virus (RSV);PICU admission for respiratory support is required in some cases. The recent Covid-19 pandemic has altered dynamics of viral transmission in the community. We aim to describe if there has been a modification in the number and characteristics of patients admitted to Italian PICUs between the pre-pandemic and post-pandemic period. METHOD(S): Multicenter retrospective observational study based on the national electronic web-based national registry of the Italian Network of PICU Study Group (TIPNet). PICU admissions due to bronchiolitis were compared from 2017 to 2022, considering the seasonal peak periods (October, 1st to April, 30th). RESULT(S): 918 patients have been admitted due to bronchiolitis to Italian PICUs in the above mentioned years. Cumulative yearly admissions are reported in Figure 1. The winter season of 2020-2021 reported a significantly lower number of admissions. RSV was consistently the reported cause in most cases throughout the years except in season 2020-2021, when it was never reported. In the 2020-2021 season, enterovirus was reported in 23% of cases. Covid-19 as cause of bronchiolitis was reported in one case in 2020- 21 and 2 cases in 2021-22. CONCLUSION(S): Covid-19 pandemic, due to possibly multiple factors, has changed the panorama of PICU admissions due to bronchiolitis in Italy. Although research is still ongoing, it seems that Covid itself is not a cause of severe bronchiolitis requiring respiratory support. (Figure Presented).

Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children.

PURPOSE: COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS: We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS: Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS: A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.