Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: a multi-institutional analysis.

BACKGROUND: The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared to prior years, focusing on intentional injury relative to the Social Vulnerability Index (SVI). METHODS: All patients <18 years meeting inclusion criteria for the National Trauma Data Bank between 1/1/2016 and 9/30/2020 at 9 Level 1 Pediatric Trauma Centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) were compared to an averaged Historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics, and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed vs expected rates of injury were analyzed. RESULTS: 47,385 patients met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016-2019. The COVID cohort included 7,068 patients and the averaged Historical cohort included 5,891 patients (SD 472), indicating a 20% increase in pediatric injury (p = 0.031). Penetrating injuries increased (722(10.2%) COVID vs 421(8.0%) Historical, p < 0.001), specifically firearm injuries (163(2.3%) COVID vs. 105(1.8%) Historical, p = 0.043). Bicycle collisions (505(26.3%) COVID vs. 261(18.2%) Historical, p < 0.001) and collisions on other land transportation (e.g. all-terrain vehicles) (525(27.3%) COVID vs. 280(19.5%) Historical, p < 0.001) also increased. Overall, SVI was associated with intentional injury (OR 7.9, 95% CI 6.5-9.8), a relationship which increased during the pandemic. CONCLUSIONS: Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic. LEVEL OF EVIDENCE: III, Prognostic and Epidemiologic Study.

COVID-19 Mortality and Progress Toward Vaccinating Older Adults - World Health Organization, Worldwide, 2020-2022.

After the emergence of SARS-CoV-2 in late 2019, transmission expanded globally, and on January 30, 2020, COVID-19 was declared a public health emergency of international concern.* Analysis of the early Wuhan, China outbreak (1), subsequently confirmed by multiple other studies (2,3), found that 80% of deaths occurred among persons aged ≥60 years. In anticipation of the time needed for the global vaccine supply to meet all needs, the World Health Organization (WHO) published the Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework and a roadmap for prioritizing use of COVID-19 vaccines in late 2020 (4,5), followed by a strategy brief to outline urgent actions in October 2021.† WHO described the general principles, objectives, and priorities needed to support country planning of vaccine rollout to minimize severe disease and death. A July 2022 update to the strategy brief§ prioritized vaccination of populations at increased risk, including older adults,¶ with the goal of 100% coverage with a complete COVID-19 vaccination series** for at-risk populations. Using available public data on COVID-19 mortality (reported deaths and model estimates) for 2020 and 2021 and the most recent reported COVID-19 vaccination coverage data from WHO, investigators performed descriptive analyses to examine age-specific mortality and global vaccination rollout among older adults (as defined by each country), stratified by country World Bank income status. Data quality and COVID-19 death reporting frequency varied by data source; however, persons aged ≥60 years accounted for >80% of the overall COVID-19 mortality across all income groups, with upper- and lower-middle-income countries accounting for 80% of the overall estimated excess mortality. Effective COVID-19 vaccines were authorized for use in December 2020, with global supply scaled up sufficiently to meet country needs by late 2021 (6). COVID-19 vaccines are safe and highly effective in reducing severe COVID-19, hospitalizations, and mortality (7,8); nevertheless, country-reported median completed primary series coverage among adults aged ≥60 years only reached 76% by the end of 2022, substantially below the WHO goal, especially in middle- and low-income countries. Increased efforts are needed to increase primary series and booster dose coverage among all older adults as recommended by WHO and national health authorities.

Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: a multi-institutional analysis.

BACKGROUND: The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared to prior years, focusing on intentional injury relative to the Social Vulnerability Index (SVI). METHODS: All patients <18 years meeting inclusion criteria for the National Trauma Data Bank between 1/1/2016 and 9/30/2020 at 9 Level 1 Pediatric Trauma Centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) were compared to an averaged Historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics, and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed vs expected rates of injury were analyzed. RESULTS: 47,385 patients met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016-2019. The COVID cohort included 7,068 patients and the averaged Historical cohort included 5,891 patients (SD 472), indicating a 20% increase in pediatric injury (p = 0.031). Penetrating injuries increased (722(10.2%) COVID vs 421(8.0%) Historical, p < 0.001), specifically firearm injuries (163(2.3%) COVID vs. 105(1.8%) Historical, p = 0.043). Bicycle collisions (505(26.3%) COVID vs. 261(18.2%) Historical, p < 0.001) and collisions on other land transportation (e.g. all-terrain vehicles) (525(27.3%) COVID vs. 280(19.5%) Historical, p < 0.001) also increased. Overall, SVI was associated with intentional injury (OR 7.9, 95% CI 6.5-9.8), a relationship which increased during the pandemic. CONCLUSIONS: Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic. LEVEL OF EVIDENCE: III, Prognostic and Epidemiologic Study.

Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: a multi-institutional analysis.

BACKGROUND: The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared to prior years, focusing on intentional injury relative to the Social Vulnerability Index (SVI). METHODS: All patients <18 years meeting inclusion criteria for the National Trauma Data Bank between 1/1/2016 and 9/30/2020 at 9 Level 1 Pediatric Trauma Centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) were compared to an averaged Historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics, and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed vs expected rates of injury were analyzed. RESULTS: 47,385 patients met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016-2019. The COVID cohort included 7,068 patients and the averaged Historical cohort included 5,891 patients (SD 472), indicating a 20% increase in pediatric injury (p = 0.031). Penetrating injuries increased (722(10.2%) COVID vs 421(8.0%) Historical, p < 0.001), specifically firearm injuries (163(2.3%) COVID vs. 105(1.8%) Historical, p = 0.043). Bicycle collisions (505(26.3%) COVID vs. 261(18.2%) Historical, p < 0.001) and collisions on other land transportation (e.g. all-terrain vehicles) (525(27.3%) COVID vs. 280(19.5%) Historical, p < 0.001) also increased. Overall, SVI was associated with intentional injury (OR 7.9, 95% CI 6.5-9.8), a relationship which increased during the pandemic. CONCLUSIONS: Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic. LEVEL OF EVIDENCE: III, Prognostic and Epidemiologic Study.

A multi-institutional study evaluating pediatric burn injuries during the COVID-19 pandemic.

During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders. The objective of this study was to investigate how the COVID-19 pandemic may have impacted the incidence of burn injuries in children. Eight Level I Pediatric Trauma Centers participated in a retrospective study evaluating children <18 years old with traumatic injuries defined by the National Trauma Data Bank. Patients with burn injuries were identified by ICD-10 codes. Historical controls from March-September 2019 ("Control" cohort) were compared to patients injured after the start of the COVID-19 pandemic from March-September 2020 ("COVID" cohort). A total of 12,549 pediatric trauma patients were included, of which 916 patients had burn injuries. Burn injuries increased after the start of the pandemic (COVID 522/6711 [7.8%] vs. Control 394/5838 [6.7%], p=0.03). There were no significant differences in age, race, insurance status, burn severity, injury severity score, intent or location of injury, and occurrence on a weekday or weekend between cohorts. There was an increase in flame burns (COVID 140/522 [26.8%] vs. Control 75/394 [19.0%], p=0.01) and a decrease in contact burns (COVID 118/522 [22.6%] vs. Control 112/394 [28.4%], p=0.05). More patients were transferred from an outside institution (COVID 315/522 patients [60.3%] vs. Control 208/394 patients [52.8%], p=0.02), and intensive care unit length of stay increased (COVID median 3.5 days [interquartile range 2.0-11.0] vs. Control median 3.0 days [interquartile range 1.0-4.0], p=0.05). Pediatric burn injuries increased after the start of the COVID-19 pandemic despite Stay-at-Home orders intended to optimize health and increase public safety.