Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Children's Health, Division of Pediatric Critical Care, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States.
Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health Sciences Center, New Orleans LA, United States; Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States.
J Pediatr Surg. 2021 May;56(5):918-922. doi: 10.1016/j.jpedsurg.2021.01.020. Epub 2021 Jan 20.
Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our two-institution experience.
Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015-2019).
There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower (p < 0.001) during COVID-19. Burn injury admissions (p < 0.001) and penetrating trauma encounters (p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased (p < 0.001). Trauma occurred among more white (p = 0.01) and privately insured (p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes (p < 0.001), pedestrians struck by automobile (p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries (p = 0.02), falls (p < 0.001), and sports related injuries (p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance (p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era (p = 0.04). For burn admissions, there was a significant increase in flame burns (p < 0.001).
Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.
创伤是儿科人群发病率和死亡率的主要原因。然而，在冠状病毒（COVID-19）居家规定导致的社会混乱期间，儿科创伤的模式和严重程度发生了变化。我们回顾了我们的两机构经验。
从大型三级大都市一级儿科创伤中心的国家创伤登记处和地区烧伤中心提取了 2015 年至 2020 年 3 月 15 日至 5 月 15 日期间，年龄小于 19 岁的儿童的儿科创伤急诊（ED）就诊和儿科烧伤入院数据。主要结局是 COVID-19（2020 年）时期与 COVID-19 前时期（2015-2019 年）之间就诊的差异。
COVID-19 时期有 392 例儿科创伤就诊，而 COVID-19 前时期分别有 451、475、520、460、432（平均 467.6）例。COVID-19 期间整体创伤入院和 ED 创伤就诊明显减少（p<0.001）。烧伤入院（p<0.001）和穿透性创伤就诊（p=0.002）增加，而钝性创伤就诊减少（p<0.001）。更多白人（p=0.01）和私人保险（p<0.001）的儿童发生创伤，但怀疑虐待、伤害严重程度、死亡率、年龄或性别无差异。亚分析显示机动车事故（p<0.001）、被汽车撞击的行人（p<0.001）、全地形车/摩托车/自行车/滑板车相关损伤（p=0.02）、跌倒（p<0.001）和运动相关损伤（p<0.001）显著减少。创伤发生在操场或家庭游乐设备（如蹦床）的情况减少，接近显著（p=0.05）。COVID-19 期间人际暴力（袭击、NAT、自残）减少（p=0.04）。烧伤入院中火焰烧伤显著增加（p<0.001）。
居家规定改变了社会模式，导致整体和钝性创伤减少。然而，穿透性和烧伤损伤的比例增加。由于压力增加和在家时间增加，医护人员应高度怀疑虐待和忽视。
