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Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003273


Background: Fractures are a common cause of pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life including social distancing, partial cessation of youth sports, and school closings, all of which could have a major impact on the incidence of pediatric fractures. Prior work has demonstrated a significant reduction in fracture burden during the early pandemic;however, few have examined pediatric fractures in the period after lifted restrictions or on a national level. The purpose of this study was to compare pediatric fracture rates in the United States during the COVID-19 pandemic to previous seasonally-adjusted injury rates using the National Electronic Injury Surveillance System (NEISS) database. Methods: The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0-17yo) patients. Studied demographic variables included age, sex, body region injured, disposition, and location of injury. Using a quasi-experimental, interrupted time series design, we constructed linear regression models for number of fractures per month that included a linear time trend, month of injury, a binary variable representing whether the fracture occurred after February 2020, and number of months post-March 2020 to allow the effect of restrictions to change over time. The differential impact of COVID-19 on fracture rate by each demographic variable was then tested using interaction terms. Results: Our sample consisted of 121,803 cases representing 2,959,421±372,337 fractures nationally. Monthly incidences (Figure 1) identified a 32% decrease in fractures per month after February of 2020 (Overall B=-11,400 fractures 95% Credible Interval[-17,600, -5,200]), and the decay of this effect did not reach significance. We found significant effect modification by age, body region, location, and disposition (p<0.05, Table 1). Children (6-11yo) experienced 44% fewer fractures (-5,070 [-7,590, -2,570]) while adolescent injuries declined 34% (-5,300 [-7,760, -3,020]). A 93% reduction in fractures at school (-5,050 [-6,870, -3,250]) and a 69% decrease in those during sports (-7,570 [-9,380, -5,750]) was identified. Fractures that did not require hospitalization decreased by 35% (-11,200 [-16,890, -5,630]). Conclusion: A nationally representative injury database demonstrated a 32% decline in monthly pediatric fractures during the COVID-19 pandemic that persisted into the latter half of 2020. These trends were identified to be most attributable to a reduction in less severe, extremity fractures among older children sustained at school and in sports. In contrast, more severe injuries or those in younger children remained relatively unaffected. Our findings provide unique insight into the epidemiology of pediatric fractures and demonstrate a baseline need for musculoskeletal care among young children and orthopaedic injuries necessitating hospitalization, even in the setting of a national shutdown. (Table Presented).

Orthopaedic Journal of Sports Medicine ; 10(5 SUPPL 2), 2022.
Article in English | EMBASE | ID: covidwho-1916583


Background: The COVID-19 pandemic has had a tremendous impact on youth sports participation for children and adolescents in the United States. Prior work demonstrated that pandemic-related closures led to a significant reduction in pediatric sports-related injury in the first half of 2020. However, these trends have yet to be evaluated on a national level and during the latter half of the year when organized youth sports began to re-emerge. Purpose: To estimate monthly and annual trends in youth sports-related injury over the last 5 years using a national injury database in order to measure the impact of the COVID-19 pandemic on overall and sport-specific rates of injury. Methods: We retrospectively reviewed data from the National Electronic Injury Surveillance System (NEISS) database identifying children and adolescents (0-18yo) presenting to US emergency departments with sport participation product codes (Table 1). Cases associated with >1 product code were excluded. The monthly and annual frequency of sports-related injuries was estimated. Quasi-experimental interrupted time series analysis was performed using the period of March-December 2020 as a binary variable. Differences in total and sport-specific injury estimates were calculated with pre-and post-trend analysis of the interrupted time series. Results: Our study criteria identified 152,560 youth sports-related injury cases corresponding to a national estimate of 4,582,892 injuries from 2016-2020 (95% CI=4,420,534-4,745,250). The mean yearly estimate from 2016-2019 was 1,041,944 injuries [890,047-1,193,841]. An estimated 415,115 injuries [357,779-480,594] occurred in 2020. Seasonal peaks in September and May were identified. There was a statistically significant decrease in national youth sportsrelated injuries that coincided with the nationwide COVID-19 shutdown in March 2020 (56,945 [33,143-80,747] fewer monthly injuries (P < 0.0001)). From March-December 2020, an estimated 457,221 [388,450-525,992] fewer sportsrelated injuries occurred than would have been expected based on prior trends. Sport-specific analyses (Table 1) demonstrated the greatest reduction of estimated injuries from March-December 2020 occurred in basketball (137,772 fewer injuries [130,192-145,246]), football (123,345 fewer injuries [86,883-159,807]), and soccer (70,383 fewer injuries [65,849-74,919]). Estimates of injuries associated with wrestling, ice hockey, and cheerleading had the greatest proportional reduction during the March-December time period (99%, 93%, and 79% respectively.) Conclusion: There was a significant reduction in youth sports-related injuries in 2020 coinciding with the nationwide COVID-19 shutdowns in March 2020 and persisting throughout the remainder of the year. Reduced injury burden was most notable for contact sports including basketball, football, and soccer.