Increased Medical Severity of Trauma Admissions to the Picu during the Covid-19 Pandemic

ABSTRACT

INTRODUCTION: It has been suggested that the coronavirus-19 disease (COVID-19) pandemic and associated community containment measures led to hesitancy among patients and their parents/guardians to report to hospitals for care. We hypothesized that the clinical condition of trauma patients admitted to the PICU was more severe during the COVID-19 pandemic in 2020 and early 2021 compared to previous years. METHOD(S) We completed a retrospective, crosssectional, study at a tertiary children's hospital by comparing admissions to our PICU between March 2020 - March 2021, during which COVID-19 and community pandemic mitigation measures occurred, to those during the same period in the previous three years. All patients admitted to the PICU for trauma were included. Severity was measured using the pediatric risk of mortality (PRISM) score estimated probability of death. Trauma admissions between COVID-19 and non-COVID-19 epochs were compared using negative binomial regression. Demographic and clinical characteristics of patients admitted during pre-COVID-19 and COVID-19 epochs were compared using Fisher exact and Mann-Whitney U rank sum tests. The normality of data was assessed using the Shapiro-Wilk test. RESULT(S) Total trauma PICU admissions during COVID-19 pandemic months were similar to the same months in the preceding three years (mean 4.5/month, 95%-CI 3.5 - 5.9/ month vs. mean 3.6/month 95%-CI 3.0 - 4.3/month, P = 0.133), although overall PICU admissions per month were lower (-19%, P< 0.001). Trauma patients admitted during COVID-19 had estimated median mortality more than twice as high as patients admitted during the non-COVID epoch (1.1%, interquartile range 0.6 - 1.8% vs. 0.5%, interquartile range 0.3 - 1.3%, P = 0.002). Age, sex, race and type of trauma (motor vehicle accident/gunshot wound/fall/all-terrain vehicle or bike accident/assault) were similar between the two time periods (all P > 0.05). CONCLUSION(S) These findings suggest that the COVID-19 pandemic was associated with increased severity in pediatric traumatic injuries, and possible hesitation to seek care earlier. These findings add to existing knowledge about increased trauma severity at presentation during a period of communicable disease spread and mitigation measures;these results may provide insight for future outbreak management.