Incidence of pediatric injury visits decreased while trauma surgeries remained stable during the first and second waves of the COVID-19 pandemic in Finland: a register-based study

Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review

PURPOSE

The study investigates changes in the injury characteristics of hospitalised children in a paediatric trauma centre during the COVID-19 pandemic.

METHODS

Data from injured children from the pre-pandemic year 2019 were compared to the pandemic year 2020 using Pearson's chi-squared test and the Mann-Whitney U test. The period of highly restrictive regulations (HRP) was evaluated separately. A comprehensive literature review with defined search terms resulted in a descriptive data synthesis.

RESULTS

Data from 865 patients indicated reductions in admissions of 5.6% and 54.4% during the HRP. In 2020, the hospitalisation time was longer (2.2 ± 2.7 days in 2019 vs. 2.4 ± 2.6 in 2020, p = 0.045); the proportions of wounds requiring surgical therapy (p = 0.008) and of observational treatments, primarily for mild brain injuries (p = 0.046), were higher; and conservative treatments, primarily for contusions, were lower (p = 0.005). There were no significant changes in age, location of lesions, or frequency of surgical therapy; nor were there differences in the HRP, except for fewer injuries in school and kindergarten (p < 0.001). The literature review summarises the main results of 79 studies.

CONCLUSION

Limited resources did not alter the indications for surgical therapy. Further studies should examine whether the more common injuries sustained at home were caused by excessive work/childcare demands on parents. Reduced inpatient conservative treatment implies that hospital resources possibly were overused previously. The literature offers answers to many detailed questions regarding childhood injuries during a pandemic and more efficient safe treatment. Registration Ethical committee of RWTH Aachen University EK 22-320; Center for Translational & Clinical Research RWTH Aachen University (CTC-A) 21-430.

Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis

BACKGROUND

The evidence shows a reduction in pediatric emergency department (PED) flows during the early stages of the COVID-19 pandemic. Using interrupted time-series analysis, we evaluated the impact of different stages of the pandemic response on overall and cause-specific PED attendance at a tertiary hospital in south Italy. Our methods included evaluations of total visits, hospitalizations, accesses for critical illnesses and four etiological categories (transmissible and non-transmissible infectious diseases, trauma and mental-health) during March-December 2020, which were compared with analogous intervals from 2016 to 2019; the pandemic period was divided into three segments: the "first lockdown" (FL, 9 March-3 May), the "post-lockdown" (PL, 4 May-6 November) and the "second lockdown" (SL, 7 November-31 December). Our results showed that attendance dropped by a mean of 50.09% during the pandemic stages, while hospitalizations increased. Critical illnesses decreased during FL (incidence rate ratio -IRR- 0.37, 95% CI 0.13, 0.88) e SL (IRR 0.09, 95% CI 0.01, 0.74) and transmissible disease related visits reduced more markedly and persistently (FL: IRR 0.18, 95% CI 0.14, 0.24; PL: IRR 0.20, 95% CI 0.13, 0.31, SL: IRR 0.17, 95% CI 0.10, 0.29). Non-infectious diseases returned to pre-COVID-19 pandemic levels by PL. We concluded that that the results highlight the specific effect of the late 2020 containment measures on transmissible infectious diseases and their burden on pediatric emergency resources. This evidence can inform resource allocation and interventions to mitigate the impact of infectious diseases on pediatric populations and the health-care system.

Effect of national COVID-19 lockdown on the incidence of muscle, tendon and ligament injuries and related surgical procedures in the working-aged Finnish population

INTRODUCTION

The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures.

MATERIALS AND METHODS

This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18-34, 35-50 and 51-65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017-2019.

RESULTS

Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33-0.80), (IRR 0.53, CI 0.31-0.91), (IRR 0.60, CI 0.38-0.95), respectively. An increase in 18-34 years of age group was detected in June (IRR 1.49, CI 1.05-2.13). Lower extremity injuries decreased in 18-34 years of age group in March (IRR 0.62, CI 0.43-0.90) and April (IRR 0.60, CI 0.42-0.87). A decrease on the incidence of surgeries was observed in April for the 35-50 (IRR 0.53, CI 0.29-0.97) and 51-65 years of age groups (IRR 0.58, CI 0.34-0.98).

CONCLUSIONS

The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland.