Polytrauma in children increased in COVID-19 pandemic despite fewer orthopedic injuries
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CHICAGO — Despite a reduction in pediatric patients presenting with orthopedic injuries during the COVID-19 pandemic, results showed these patients had an increase in polytrauma requiring more procedures and worse hospital outcomes.
In a retrospective review of all recorded injuries from hospitals with Pennsylvania Trauma System Foundation designation, Ajith Malige, MD, and colleagues collected patient demographics, injuries, hospital stays and mortality among 1,112 pediatric patients with documented traumatic orthopedic injuries. Researchers compared data between patients who presented to the hospitals during April 2020 (COVID cohort) with patients who presented to the hospitals during April 2017, April 2018 and April 2019 (pre-COVID cohort).
Malige noted a 41% reduction of pediatric patients presenting with orthopedic injuries during the pandemic.
“Most injuries occurred at home both pre-COVID and in the COVID cohorts,” Malige said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. However, he added that a greater proportion of injuries occurred at home in the COVID cohort.
“This was due to a decreasing proportion of injuries sustained at sport and school locations in the COVID cohort,” he said.
The most common mechanism of injury was falls in both groups, according to Malige. He noted a lower number of sporting events for children during COVID was the primary reason for overall differences in injury mechanisms.
“The pre-COVID cohort sustained a total of 2,422 injuries, which averaged 807 per month, while the COVID cohort sustained 525 injuries, representing a 35% reduction during the pandemic,” Malige said. “There were 898 procedures performed in these injuries, with a reduction of 22% during the pandemic.”
Despite the decrease in pediatric patients presenting to trauma centers during the pandemic, on average, each patient presented with more injuries and underwent more procedures, which Malige said suggests pediatric patients experienced more polytrauma with greater severity of injuries requiring intervention during the pandemic. He added patients in the COVID cohort had a longer mean hospital length of stay and a greater mean number of days spent in the ICU. Results showed a 75% increase in the absolute number of pediatric deaths per month in the COVID cohort compared with the pre-COVID cohort, and Malige said pediatric orthopedic patients were three times more likely to die during the pandemic.
“Finally, our data showed that patients were almost twice as likely to present injuries secondary to child abuse and 2.4 times more likely to present with a positive dose of drug screening on admission during the COVID pandemic compared to previously,” Malige said.
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Malige A, et al. Paper 437. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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