Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
J Surg Res. 2024 Jun;298:169-175. doi: 10.1016/j.jss.2024.03.034. Epub 2024 Apr 13.
The COVID-19 pandemic created difficulties in access to care. There was also increased penetrating trauma in adults, which has been attributed to factors including increased firearm sales and social isolation. However, less is known about the relationship between the pandemic and pediatric trauma patients (PTPs). This study aimed to investigate the national incidence of penetrating trauma in PTPs, hypothesizing a higher rate with onset of the pandemic. We additionally hypothesized increased risk of complications and death in penetrating PTPs after the pandemic versus prepandemic.
We included all PTPs (aged ≤17-years-old) from the 2017-2020 Trauma Quality Improvement Program database, dividing the dataset into two eras: prepandemic (2017-2019) and pandemic (2020). We performed subset analyses of the pandemic and prepandemic penetrating PTPs. Bivariate analyses and a multivariable logistic regression analysis were performed.
Of the 474,524 PTPs, 123,804 (26.1%) were from the pandemic year. The pandemic era had increased stab wounds (3.3% versus 2.8%, P > 0.001) and gunshot wounds (5.5% versus 4.0%, P < 0.001) compared to the prepandemic era. Among penetrating PTPs, the rates and associated risk of in-hospital complications (2.6% versus 2.8%, P = 0.23) (odds ratio 0.90, confidence interval 0.79-1.02, P = 0.11) and mortality (4.9% versus 5.0%, P = 0.58) (odds ratio 0.90, confidence interval 0.78-1.03, P = 0.12) were similar between time periods.
This national analysis confirms increased penetrating trauma, particularly gunshot wounds in pediatric patients following onset of the COVID-19 pandemic. Despite this increase, there was no elevated risk of death or complications, suggesting that trauma systems adapted to the "dual pandemic" of COVID-19 and firearm violence in the pediatric population.
COVID-19 大流行给医疗保健的可及性带来了困难。成年人中也有更多的穿透性创伤，这归因于包括枪支销售增加和社会隔离在内的因素。然而，关于大流行与儿科创伤患者（PTP）之间的关系知之甚少。本研究旨在调查全国范围内 PTP 穿透性创伤的发病率，假设大流行期间发病率更高。我们还假设大流行后穿透性 PTP 的并发症和死亡风险增加。
我们纳入了 2017-2020 年创伤质量改进计划数据库中所有 PTP（年龄≤17 岁），将数据集分为两个时期：大流行前（2017-2019 年）和大流行期间（2020 年）。我们对大流行期间和大流行前的穿透性 PTP 进行了亚组分析。进行了双变量分析和多变量逻辑回归分析。
在 474524 名 PTP 中，有 123804 名（26.1%）来自大流行年。与大流行前时期相比，大流行期间有更多的刺伤（3.3%比 2.8%，P>0.001）和枪伤（5.5%比 4.0%，P<0.001）。在穿透性 PTP 中，院内并发症的发生率和相关风险（2.6%比 2.8%，P=0.23）（比值比 0.90，95%置信区间 0.79-1.02，P=0.11）和死亡率（4.9%比 5.0%，P=0.58）（比值比 0.90，95%置信区间 0.78-1.03，P=0.12）在两个时间段之间相似。
这项全国性分析证实，COVID-19 大流行后，儿科患者穿透性创伤，特别是枪伤增加。尽管有这种增加，但死亡或并发症的风险并没有增加，这表明创伤系统适应了 COVID-19 和儿科人群中枪支暴力的“双重大流行”。
