Beware of the bicycle! An increase in paediatric bicycle related injuries during the COVID-19 period in Western Australia

Hospital-admitted drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic

OBJECTIVES

To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

DESIGN

Retrospective analysis of administrative hospital admission records.

SETTING

Hospital admissions recorded in the Victorian Admitted Episodes Dataset.

PARTICIPANTS

Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code.

MAIN OUTCOME MEASURES

Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic.

RESULTS

There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate.

CONCLUSIONS

Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis

BACKGROUND

Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

METHODS

The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs).

RESULTS

A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period ( R2 =0.899; P <0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%).

CONCLUSIONS

Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males.

LEVEL OF EVIDENCE

Level III-prognostic.

A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic

BACKGROUND

Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic.

METHODS

This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020.

RESULTS

The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019.

CONCLUSIONS

The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.

Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Brain Injury in Brazil

Aim In response to the coronavirus 2019 disease (COVID-19) pandemic, governments worldwide implemented measures to prevent infection, resulting in restricted school activities, restricted children's freedom of movement, and increased risk of violence and injuries at home, including traumatic brain injury (TBI), among children. In Brazil, the consequences of the COVID-19 pandemic on the causes, severity, and mortality of pediatric TBI have not yet been investigated. Thus, our study aimed to determine whether the COVID-19 pandemic has affected the epidemiology of pediatric TBI among Brazilian children. Materials and methods We investigated the patients with TBI aged <18 years who visited a tertiary trauma center in Brazil in 2019 and 2020. TBI-related variables, such as classification, mechanism, clinical manifestations, need for intervention, morbidity, and mortality, were recorded. Furthermore, we used a nationwide databank to collect information on mortality from external causes of trauma and violence in the pediatric population in 2019 and 2020. The Mann-Whitney test was used to compare quantitative variables related to the mechanisms and severity of TBI in both periods in order to determine the impact of the COVID-19 pandemic. Results Of the patients with traumatic brain injury, 1371 visited the trauma center in 2019 and 1052 in 2020. No difference was noted in the incidence rate of abusive head trauma between these periods (p=0.142) or in mortality from violence in Brazil. Recreational causes of pediatric TBI increased during the first year of the COVID-19 pandemic in Brazil and falls from bicycles significantly increased during the pandemic (p<0.001). Conclusion A global reduction in pediatric admissions to emergency rooms as well as no impact on mortality and severity of pediatric TBI were observed during the COVID-19 pandemic in Brazil. Additionally, a public education program regarding child safety during recreational activities, particularly how to avoid falls from bicycles was recommended.

Epidemiology of Paediatric Trauma During National Lockdown: A Retrospective Study With 12 Months of Follow-Up

Introduction The COVID-19 pandemic and its associated preventative measures such as national lockdown dramatically changed the daily activities of children. This paper aims to compare the epidemiology of paediatric orthopaedic trauma presentation, management and outcomes during the school closure period with the matched pre-pandemic period in 2019. Methods This was a retrospective cohort study of data collected from the West Yorkshire Trauma Network, comprising a major trauma centre, Leeds General Infirmary, and five peripheral trauma units. All patients aged 0-18 years who required trauma unit management during the school closure period (18 March 2020-25 May 2020) were included. Cases for the matched period in 2019 were analysed for baseline comparison. Patient demographics, mechanism and anatomical location of injury, management and follow-up were assessed. Results In the 2020 and 2019 cohorts, 286 and 575 injuries were observed, respectively. In the 2020 cohort, we observed a 50.3% (n=289) fall in paediatric trauma presentation and a significant proportional reduction in referrals from the emergency department (22% (n=63) versus 53% (n=305); p<0.001). There was also a significant reduction in the average age at presentation by more than one year (p<0.001). Sports-related injuries decreased significantly (n=16 (5.6%) versus n=127 (22.1%); p<0.001). While the proportion of ride-on injuries increased significantly, overall numbers remained similar (n=63 (22%) versus n=61 (10.6%); p<0.0001). Non-accidental injury (NAI) concerns rose significantly (n=9 (3.1%) versus n=4 (0.7%); p=0.01), but the absolute number of confirmed NAI cases stayed the same (n=2). There was a proportional increase in upper limb injuries (64.3% (n=184) versus 58.4% (n=336); p>0.05) and a proportional reduction in lower limb injuries (32.1% (n=92) versus 35.5% (n=204); p>0.05). However, the rate of tibial shaft injuries rose significantly (10.1% (n=29) versus 5.2% (n=30); p=0.02). The use of conservative management increased with a significant delay in average time to surgery from the date of injury (8.5 days versus 3.1 days; p=0.01). Patients who were only followed up with a telephone consultation rose significantly (23% (n= 66) versus 6% (n=35); p<0.001). Re-presentation rate increased significantly (1.4% (n=4) versus 0.2% (n=12); p=0.04). Conclusion Our study showed a reduction in paediatric trauma presentations during the pandemic and a significant reduction in the average age at presentation. This change has been accompanied by a shift in the mechanism and anatomical location of injury, management and subsequent follow-up.

Pediatric outdoor recreational injuries: another hidden concern during the COVID-19 pandemic

BACKGROUND

Recreational equipment sales rose significantly during the COVID-19 pandemic. This study investigated changes in the incidence of pediatric emergency department (PED) visits related to outdoor recreational activities during the COVID-19 pandemic.

METHODS

A retrospective cohort study was conducted at a large children's hospital with a level 1 trauma center. Data were obtained from PED electronic medical records of children 5-14 years with a visit from March 23-September 1 in years 2015-2020. Patients with an ICD-10 code for injury associated with recreation and use of common outdoor recreational equipment were included. Initial pandemic year, 2020, was compared with pre-pandemic years (2015-2019). Data collected included patient demographics, injury characteristics, deprivation index, and disposition. Descriptive statistics were used to characterize the population and Chi-squared analysis was used determine relationships between groups.

RESULTS

There were 29,044 total injury visits during the study months with 4715 visits (16.2%) due to recreational mechanisms. A higher proportion of visits due to recreational injury visits occurred during the COVID pandemic (8.2%) compared to before (4.9%). Comparing patients included within the two times, were no differences in sex, ethnicity, or ED disposition. During the COVID pandemic, there was a higher percentage of White patients (80% vs 76%) and patients with commercial insurance (64% vs 55%). There was a significantly lower deprivation index for patients injured during the COVID pandemic. There were more injuries due to bicycles, ATV/motorbike, and non-motorized wheeled vehicles during the COVID pandemic.

CONCLUSIONS

During the COVID-19 pandemic, there was an increase in bicycle, ATV/motorbike, and non-motorized wheeled vehicle injuries. White patients with commercial insurance were more likely to be injured compared to years prior. A targeted approach to injury prevention initiatives should be considered.

Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic

BACKGROUND

The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated.

OBJECTIVE

We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries.

PARTICIPANTS AND SETTING

This study included children aged 0-4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada.

METHODS

We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury.

RESULTS

Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1-23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7-19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000.

CONCLUSIONS

Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.

Lockdowns and cycling injuries: temporal analysis of rates in Quebec during the first year of the pandemic

INTRODUCTION

Cycling increased in popularity during the COVID-19 pandemic, but the impact on cycling injuries is not known. We examined the effect of lockdowns on cycling injury hospitalizations.

METHODS

We identified hospitalizations for cycling injuries in Quebec, Canada, between April 2006 and March 2021. We used rate ratios (RR) and 95% confidence intervals (CI) to compare hospitalization rates by type of cycling injury and anatomical site during two waves of the pandemic. We performed interrupted time series regression to assess the effect of lockdowns on monthly cycling injury hospitalization rates, according to age, sex and other characteristics.

RESULTS

There were 2020 hospitalizations for cycling injuries between March 2020 and March 2021, including 617 during the first lockdown and 67 during the second lockdown. Compared with the period before the pandemic, risk of cycling-related injuries during the first lockdown increased the most for fractures (RR = 1.44; 95% CI: 1.26- 1.64) and head and neck injuries (RR = 1.59; 95% CI: 1.19-2.12). Cycling injury hospitalization rates increased significantly among adults, adolescents and individuals from socioeconomically advantaged neighbourhoods or those with low concentrations of racialized people every month of the first lockdown. The second lockdown was not associated with cycling injuries.

CONCLUSION

The first lockdown triggered a sharp increase in cycling injury hospitalizations, especially among adults, adolescents and individuals from socioeconomically advantaged and less racialized neighbourhoods.

The Impact of the COVID-19 Pandemic on Pediatric Bicycle Injury

Bicycling is a common childhood activity that is associated with significant injury risk. This study's aim was to assess pediatric bicycle injury epidemiology and impacts of the COVID-19 pandemic. We conducted a cross-sectional evaluation of patients age < 18 years presenting with bicycle injury to a pediatric trauma center. A pre-pandemic period (1 March 2015-29 February 2020) was compared to the pandemic period (1 March 2020-28 February 2021). A total of 611 injury events for children < 18 years were included (471 pre-pandemic events and 140 pandemic events). The relative frequency of pandemic injuries was greater than pre-pandemic injuries (p < 0.001), resulting in a 48% increase in pandemic period injuries versus the pre-pandemic average (141 pandemic vs. 94.4/year pre-pandemic). Individuals of female sex represented a larger proportion of injuries in the pandemic period compared to the pre-pandemic period (37% pandemic vs. 28% pre-pandemic, p = 0.035). Injuries were more common on weekends versus weekdays (p = 0.01). Time series analysis showed a summer seasonality trend. Localizing injury events to ZIP codes showed regional injury density patterns. During COVID-19, there was an increase in bicycle injury frequency and proportional shift toward more injuries involving individuals of female sex. Otherwise, injury patterns were largely unchanged. These results demonstrate the necessity of safety interventions tailored to community needs.

Injury-Related Pediatric Emergency Department Visits in the First Year of COVID-19

OBJECTIVES

To describe the epidemiology of pediatric injury-related visits to children's hospital emergency departments (EDs) in the United States during early and later periods of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS

We conducted a cross-sectional study using the Pediatric Health Information System, an administrative database to identify injury-related ED visits at 41 United States children's hospitals during the SARS-CoV-2 pandemic period (March 15, 2020 to March 14, 2021) and a 3 year comparator period (March 15-March 14, 2017-2020). For these 2 periods, we compared patient characteristics, injury type and severity, primary discharge diagnoses, and disposition, stratified by early (March 15, 2020 to June 30, 2020), middle (July 1, 2020 to October 31, 2020), and late (November 1, 2020 to March 14, 2021) pandemic periods.

RESULTS

Overall, ED injury-related visits decreased by 26.6% during the first year of the SARS-CoV-2 pandemic, with the largest decline observed in minor injuries. ED injury-related visits resulting in serious-critical injuries increased across the pandemic (15.9% early, 4.9% middle, 20.6% late). Injury patterns with the sharpest relative declines included superficial injuries (41.7% early) and sprains/strains (62.4% early). Mechanisms of injury with the greatest relative increases included (1) firearms (22.9% early; 42.8% middle; 37% late), (2) pedal cyclists (60.4%; 24.9%; 32.2%), (3) other transportation (20.8%; 25.3%; 17.9%), and (4) suffocation/asphyxiation (21.4%; 20.2%; 28.4%) and injuries because of suicide intent (-16.2%, 19.9%, 21.8%).

CONCLUSIONS

Pediatric injury-related ED visits declined in general. However, there was a relative increase in injuries with the highest severity, which warrants further investigation.

Broadband internet subscription rates and opioid prescribing via telemedicine during the COVID-19 pandemic

PURPOSE

In response to the COVID-19 pandemic, the US DEA allowed controlled substance prescriptions to be issued following a telemedicine encounter. This study evaluated changes in opioid prescribing in Kentucky counties with low and high rates of broadband subscription before, during, and after a series of statewide emergency declarations that may have affected health care access.

METHODS

The study used the prescription drug monitoring program to analyze records of opioid analgesic prescriptions dispensed to opioid-naïve individuals in high (N = 26) and low (N = 94) broadband access counties during 3 periods: before a state of emergency (SOE) and executive order (EO) limiting nonemergent health care services (January 2019-February 2020), while the EO was active (March-April 2020), and after health care services began reopening (May-December 2020). Marginal generalized estimating equations-type negative binomial models were fit to compare prescription counts by broadband access over the 3 periods.

FINDINGS

Rates of opioid dispensing to opioid-naïve individuals decreased significantly during the EO, but increased nearly to pre-SOE levels after health care services began reopening. Dispensing rates in low broadband counties were higher than those in high broadband counties during all time periods, although these differences were negligible after adjusting for potential confounders. During the EO, prescriptions were written for longer days' supply in both county types.

CONCLUSIONS

The overall dramatic reduction in opioid prescribing rates should be considered when evaluating annual opioid prescribing trends. However, broadband subscription rate did not appear to influence opioid prescriptions dispensed in Kentucky during the EO.