ABSTRACT
Background: The effect of the COVID 19 pandemic and public shutdowns remains to be fully elucidated, particularly in the pediatric population. Clinically, and in the literature, urgent and emergent disease processes that typically have a stable yearly incidence, were thought to have declined during the height of the pandemic. One such disease, acute appendicitis, has been studied both in the US and abroad with varying results. There appears to be a trend toward higher rates of complicated appendicitis and overall decrease of acute appendicitis presentations to healthcare centers during the pandemic. We set out to determine if these trends hold true in a large pediatric population. Methods: The Partners For Kids database, an accountable care organization database that comprises approximately 325,000 unique children annually, was queried for cases of acute appendicitis, including complicated, uncomplicated, and unspecified from April 1st - August 31st 2017-2020. The overall monthly rate/100,000 covered lives in the PFK database from April-August was calculated each year and compared for overall acute appendicitis diagnosis. The rate of complicated and uncomplicated appendicitis/100 cases of appendicitis were calculated from April-August for each year and compared as well. P-values < 0.05 were considered significant. Results: The overall monthly rate of acute appendicitis/100,000 covered lives in the PFK database was significantly lower in 2020 compared to 2017 and 2018, but not compared to 2019 (2.0% in 2020 vs 3.2% 2017 and 2018, 2.8% 2019, p <0.01, Figure 1). The rate of complicated appendicitis cases showed a decline over the study time period, with both 2019 and 2020 significantly lower than 2018 and 2017 (55.8% 2017, 53.7% 2018, 23.9% 2019, 20.6% 2020, p <0.01). The rate of uncomplicated appendicitis was significantly higher in 2020 compared to 2017, but otherwise the rates between years were not significant (46.3% 2017 and 2018, 71.4% 2019, 79.4% 2020, p = 0.02). See Figure 2. Conclusion: The results of this study using an accountable care organization database indicate that 2020 was not an outlier with regard to overall presentation of acute appendicitis, nor delayed presentation as indicated by complicated appendicitis rates in the pediatric population. Looking beyond the immediately preceding year to the pandemic demonstrates that overall rates of appendicitis had been declining and reached significance in 2020 compared to two and three years prior to the pandemic but not 2019. Rates of complicated appendicitis underwent a large decline one year prior to 2020 and remained low during the pandemic. Uncomplicated rates of appendicitis have followed a reciprocal pattern. While many secondary effects of the COVID 19 pandemic remain to be seen, acute appendicitis appears to have maintained its prior trajectory, contrary to smaller studies and those comparing 2020 to only the immediately preceding 1 or 2 years. (Figure Presented).
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.
ABSTRACT
Background: Within pediatrics, the use of telemedicine has grown considerably within the past decade, mostnotably within primary care and behavioral health. However, within pediatric surgery the increase in use hasbeen modest. In response to COVID-19, many healthcare institutions implemented strategies to curb thespread of the virus, including restricting non-emergent clinic appointments and quickly rolling outtelemedicine options for patients. The utility of telemedicine options beyond the COVID-19 restrictive periodhas not been studied. The purpose of this study is to assess the state of interest in telemedicine for caregiverspresenting to a pediatric surgery clinic prior to COVID-19 and to evaluate the potential benets of continuingtelemedicine use within pediatric surgery based on the caregiver perspective. Methods: Following IRBapproval, caregivers for all patients that presented to a general pediatric surgery clinic from January 1, 2020 toMarch 1, 2020, were considered for enrollment. Subjects were asked to complete a voluntary and anonymous survey. Survey responses were recorded directly into REDCap by participants. Categorical variables wereevaluated using frequencies and reported as percentages. Results: In total, 58 caregivers completed a survey.The majority (51%) of respondents were between 31-40 years old, with 71% identifying as Caucasian and 22%as African American. A fourth (25%) of respondents traveled at least 100 miles, with more than one-third (36%)spending a minimum of 2 hours in travel time. To get to and from the clinic appointment, 69% reportedspending at least $10 in fuel, with 13% spending more than $50. Three-quarters (75%) of participants reportedworking outside of the home, and the majority (53%) had to miss work for the appointment, resulting inmissed wages for 41% of respondents. All caregivers had a cellphone and 93% had access to a computer ortablet, with 87% reporting daily internet use and 71% reporting use of video chat at least once per week. Only26% of respondents were familiar with telemedicine prior to taking the survey. However, following a briefdescription, 66% responded that they would be interested in remote appointments, with 74% citing cost as areason and 69% stating that time spent traveling was an important factor. For 91% of respondents the mostimportant factor related to the visit was getting the correct diagnosis. Conclusion: The COVID-19 restrictiveperiod has led to increased use of telemedicine within pediatric surgery. Prior to COVID-19 most caregiverspresenting to a pediatric surgery clinic were unfamiliar with telemedicine options, however, the majority wereinterested in the benets afforded by remote evaluation. Future studies are needed to determine how best tocontinue the use of telemedicine for the treatment of pediatric surgery patients beyond the restrictive period.