The COVID-19 pandemic had a huge global impact on healthcare systems that affected all medical services, including burn care facilities. This paper analyzes the effects of this medical crisis on pediatric burn injuries by comparing patient data from 2019 (pre-pandemic) and 2020 (during the pandemic) at a national burn center in Romania. The study included, overall, 676 patients, out of which 412 were admitted in 2019. In 2020, the admissions decreased by 35.9% (n = 264). However, moderate and severe burns remained constant and burn severity increased in 2020, with a larger total body surface area affected on average. Surgical management rates and hospital stay duration increased in 2020 from 18% to 39% and from 7 days to 11 days, respectively. Admissions to the intensive care unit and mortality rates remained similar between 2019 and 2020. Scalds were the leading cause of burns in both years; however, in 2020, they affected a larger total body surface area. Contact burns decreased significantly in 2020 from 10.9% to 5.2%, likely due to reduced outdoor activities. The concomitant presence of SARS-CoV-2 infection and burn injuries did not have a negative impact on complication rates, surgical management approaches, or duration of hospitalization. These findings emphasize the need to preserve dedicated burn care human and material resources during global health crises in order to offer access to the best quality of care, thus ensuring optimal patient outcomes, regardless of fluctuations in admission rates.

 Approximately 20% of victims of traumatic brain injury (TBI) in Brazil are children and adolescents, with more than 900 deaths per year.

 To describe the characteristics and epidemiological profile of children and adolescents with TBI in the city of São Paulo, Brazil, according to age groups and metropolitan area of occurrence of the events leading to trauma.

 We conducted a retrospective cross-sectional study with a review of consecutive medical records of children and adolescents with TBI hospitalized and treated at a level-1 trauma center in São Paulo between 2019 and 2023.

 In the period proposed for the study, 196 children and adolescents suffered TBIs. They had a median age of 5 (interquartile range [IQR] 10-1.75) years and were predominantly boys (71%), of white skin color/race (55%), and coming from the north zone of the metropolitan region of São Paulo (44%). Domestic accidents were the main causes of TBI (61%), followed by traffic accidents (24%). The mean length of hospital stay was of 13 (standard deviation [SD] ± 26) days, and the in-hospital mortality rate was of 3%.

 We found a predominance of children and adolescents with TBI coming from the north zone of the metropolitan region of São Paulo, with a prevalence of falls from heights above the ground among children ≤ 9 years of age and trampling among children older than this age. Preventive actions must be established after reflections on socioeconomic issues and considering the metropolitan area where the accidents occur and the age group.

In March 2020, several countries, including France, implemented a total lockdown policy to combat the spread of the COVID-19 epidemic, involving the closure of schools. This measure required children to stay at home for an extended period of time. Several studies have shown an increase in the number or proportion and severity of domestic accidents in children during this period. Santé Publique France and the paediatric emergency department of Toulouse University Hospital conducted a study on the impact of the first lockdown on the use of the emergency department due to domestic accidents in children under 15 years of age in France.

The study was conducted using data from nine French emergency departments participating in the Enquête permanente sur les accidents de la vie courante [Permanent Survey on Home and leisure injuries] (EPAC), which involves the exhaustive collection of data on emergency admissions following home and leisure injuries. The frequencies and characteristics of emergency department admissions due to domestic accidents were analysed over the period from 17 March to 11 May 2020, and compared to those over the same period in 2016-2019.

During the lockdown period, an increase in the proportion of emergency department admissions due to domestic accidents is observed in boys and children aged [2-5[years. This study showed an increase in the proportion of hospital admissions during this period. These accidents were mainly falls in outside living spaces (balcony, patio, garden, etc.). The results showed an increase in admissions for fractures and upper limb injuries.

This study shows that health policies must take into account the collateral effects of certain measures put in place to manage an epidemic. Prevention messages for parents of young children need to be strengthened and their attention drawn to the risk of certain kinds of accidents, such as falls.

During the COVID-19 pandemic, lockdown posed a number of unprecedented problems. Accidents to children are a major public health concern. This study sought to determine the impact of France's 2020 COVID-19 lockdown on hospital admissions for paediatric accidents. This study was a retrospective cohort analysis of data from the French national inpatient database. Children admitted to a French hospital for an accident from January to July 2020 and 2019 were included. The number of admissions for accidents between January and July in 2020 (the study period) vs. the same period (the control period) in 2019 was recorded. Hospital admission rate ratios (HRRs) comparing 2020 with 2019 were calculated for three periods in 2020 and 2019: before lockdown (P1, January 1 to March 15), during lockdown (P2, March 16 to May 10), and after lockdown (P3, May 11 to July 31). A total of 72,089 children were admitted to hospital for accidents between January and July 2020 (mean (SD) age, 8.7 (5.8)), and 84,961 between January and July 2019 (mean (SD) age, 9.2 (5.7)). A total of 12,864 children (18%) were admitted during the lockdown period (P2) in 2020, and 23,098 (27%) during the equivalent period in 2019 (HRR, 0.56; 95% confidence interval (CI), 0.55-0.57; p < .001). There were significantly fewer admissions for accidents in 2020 than in 2019; the HRR was 0.97 (95% CI, 0.96-0.99; p = .003) for P1 and 0.95 (95% CI, 0.93-0.96; p < .001) for P3. During the 2020 lockdown period (P2), the risk of accident-related paediatric admissions with critical care lasting for at least 1 day was lower than in 2019 (HRR 0.67; 95% CI, 0.62-0.73; p < .001).

Further research could usefully examine how parents create a safe home environment for their children.

• During the COVID-19 pandemic, lockdown posed a number of unprecedented problems. Accidents to children are a major public health concern. This study sought to determine the impact of France's 2020 COVID-19 lockdown on hospital admissions for paediatric accidents.

• The first nationwide COVID-19 lockdown in France was associated with a decrease in the absolute number of hospital admissions for paediatric accidents, for all age groups, as well as the number of accident-related paediatric hospital stays involving critical care.

The aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in US emergency departments (EDs).

This cross-sectional study analysed 2016-2020 Nationwide Emergency Department Sample (NEDS) data.

US EDs contained in the NEDS.

Participants were patients with moderate and severe TBI who visited the ED.

Probability sampling design and survey weights generated nationally representative estimates of ED visits by patient demographics, hospital characteristics and COVID-19 diagnosis and the top four leading TBI causes. To assess COVID-19 impact, we calculated the per cent change of estimated TBI ED visits and disposition outcomes from 2016 to 2019 and 2019 to 2020, and proportion and 95% CI of injury severity groups and admitted/transfer by hospital type and trauma centre level. A multivariable logistic regression model identified the mortality OR by patient demographics, injury severity, hospital characteristics and COVID-19 positive diagnosis.

In 2020, there were 527 123 ED visits nationally for TBI, 4.3% higher than 2016 but 1.0% lower than 2019. Patients with TBI transferring to short-term hospitals and other facilities increased by 16.0% and 18.2%, respectively, from 2016 to 2019 and were 3.7% and 14.1% higher in 2020 than in 2019. An estimated 3317 patients with TBI died (in ED or later in hospital) in 2020, which is 9.8% higher than 2019. Firearm-related TBI proportion was 15.1% higher in 2020 than in 2019. Patients with TBI with injury severity scores 25-75 were significantly higher at nontrauma (29.4% vs 31.9 %) and level III trauma centres (34.9% vs 38.2%) in 2020 than in 2019. Patients with TBI treated at rural hospitals had significantly higher odds of mortality (OR=1.95, CI=1.58-2.40) than those at urban hospitals.

TBI patient mortality was higher at all US hospital types and almost all trauma centre levels in 2020 than in 2019. Patients with TBI treated at rural hospitals had a significantly higher mortality risk.

The COVID-19 pandemic has claimed over one million lives in the United States and has drastically changed how patients interact with the healthcare system. Emergency medical services (EMS) are essential for emergency response, disaster preparedness, and responding to everyday emergencies. We therefore examined differences in EMS utilization and call severity in 2020 compared to trends from 2015-2019 in a large, multi-state advanced life support EMS agency serving the U.S. Upper Midwest. Specifically, we analyzed all emergency calls made to Mayo Clinic Ambulance, the sole advanced life support EMS provider serving a large area in Minnesota and Wisconsin, and compared the number of emergency calls made in 2020 to the number of calls expected based on trends from 2015-2019. We similarly compared caller demographics, call severity, and proportions of calls made for overdose/intoxication, behavioral health, and motor vehicle accidents. Subgroup analyses were performed for rural vs. urban areas. We identified 262,232 emergent EMS calls during 2015-2019 and 53,909 calls in 2020, corresponding to a decrease of 28.7% in call volume during 2020. Caller demographics shifted slightly towards older patients (mean age 59.7 [SD, 23.0] vs. 59.1 [SD, 23.7] years; p<0.001) and to rural areas (20.4% vs. 20.0%; p = 0.007). Call severity increased, with 95.3% of calls requiring transport (vs. 93.8%; p<0.001) and 1.9% resulting in death (vs. 1.6%; p<0.001). The proportion of calls for overdose/intoxication increased from 4.8% to 5.5% (p<0.001), while the proportion of calls for motor vehicle collisions decreased from 3.9% to 3.0% (p<0.001). All changes were more pronounced in urban areas. These findings underscore the extent to which the COVID-19 pandemic impacted healthcare utilization, particularly in urban areas, and suggest that patients may have delayed calling EMS with potential implications on disease severity and risk of death.

The COVID-19 pandemic compromised the principles underlying the functioning of public health, which is understood as the prevention of diseases and care for the health of entire communities. During the pandemic period, the efforts of the health system focused on patients with suspected infection and those infected with the SARS-CoV-2 virus, which led to changes in the provision of health services and the characteristics of patients receiving medical services at the pre-hospital stage. The objective of this study was to investigate the effects of the COVID-19 pandemic on potential health emergencies in paediatric patients based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The data used in the study were derived from interventions carried out by Emergency Medical Teams (EMT) in central and eastern Poland, involving patients who were under 18 years of age (n = 12,619). The data were collected from 1 January 2017 to 31 December 2022. The study used descriptive statistics, the Mann-Whitney U Test, and the Chi-square test. The study reveals that fewer paediatric patients (5.28%) were provided medical services by EMTs during the COVID-19 pandemic compared to the pre-pandemic period (5.86%). There was a decrease in the number of injuries in paediatric patients (from 42.0 to 32.7%; p < 0.001), and more patients were left at the location from which the call was made (18.9 vs. 23.9%; p < 0.001). Moreover, during the pandemic, as compared to the pre-pandemic period, there was an increase in the number of cases of pre-hospital assistance provided to paediatric patients with fever, irrespective of gender, area (village, city) or patient age. During the pandemic, paediatric patients consumed alcohol more frequently. The age of patients who were provided with assistance by EMTs decreased (median of 10.0 vs. 9.0; p < 0.001). The COVID-19 pandemic brought about changes in the prevalence of potential health emergencies in children. The incidence of injuries decreased, while the number of interventions due to fever and alcohol consumption increased. There was a reduction in the number of patients transported to the hospital. In addition, the age of patients who received medical assistance decreased. The study shows health problems that were faced by paediatric patients during the COVID-19 pandemic and, therefore, can be helpful in preparing the healthcare system for emergency situations.

Background: Despite organised efforts, the COVID-19 pandemic had a significant impact on the health status of the population and health services including the emergency medical system. The objective of the study was to investigate, based on the Emergency Medical Teams' (EMT) interventions, the impact of the COVID-19 pandemic on health and life emergencies resulting from illness cases and injuries of Polish females and males. Material and Methods: The data under analysis concern EMT interventions carried out in central and eastern Poland from 1 January 2017 to 31 December 2022 (n = 226,038). The study used descriptive statistics, the Mann-Whitney U Test, and the Chi-square test. Results: A significant increase was observed in the proportion of EMT interventions (p < 0.001) to patients with illness cases (80.30% vs. 83.17%) and a decrease in interventions to patients with injuries (19.70% vs. 16.83%) during the pandemic as compared to the pre-pandemic period. As for illness cases, the patients' ages during both periods were similar (Me = 66.00 vs. 66.00, p = 0.071). On the other hand, during the pandemic, injuries mainly affected elderly patients as compared to the pre-pandemic period (Me = 50.00 vs. 47.00, p < 0.001). The increase in the proportion of EMT interventions to patients with illness cases and the decrease in patients with injuries during the pandemic, as compared to the pre-pandemic period, concerned the area of intervention, patient's sex, and age. During the pandemic period, a significantly lower proportion of patients transported to the hospital (p < 0.001) and an increase in the proportion of patients left at the place of call (p < 0.001) were noted. Conclusions: The restrictions aimed at preventing the spread of the SARS-CoV-2 virus contributed to a reduced number of injuries without, however, reducing the number of illness cases. During the pandemic, the elderly were affected by injuries. The study indicates the need for further in-depth analyses to prepare the pre-hospital care system in Poland for the occurrence of other or similar emergencies.

Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.

Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks.

A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries.

Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted.

The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions.

Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.

Although previous studies have examined olfactory dysfunction in children, the novel coronavirus SARS-CoV-2 has certainly had an unprecedented effect on their olfaction, which could not be taken into consideration. The aim of this report was to present data on the epidemiology of olfactory dysfunction during the pandemic and compare this dataset with a pre-pandemic set. We hypothesized an increase in URTI-related olfactory dysfunction.

Data of paediatric patients consulting a smell and taste clinic between March 2020 and June 2022 were retrospectively analysed. The frequency of major causes of olfactory dysfunction was examined and compared with three subsets of an older dataset.

A total of 52 patients were included in the analysis. Most children presented with olfactory dysfunction due to upper respiratory tract infection (URTI) (52%). Congenital olfactory dysfunction was present in 34% of cases. Sinonasal disorders and idiopathic cases accounted for 6 and 4%, respectively, whereas head trauma was the least common cause (2%). This was in contrast with the results of the older set. The frequency of URTI-related olfactory dysfunction increased significantly. The frequency of head-trauma-related or congenital olfactory dysfunction showed marked reductions. There were no significant differences regarding the other aetiologies between our patient cohort and the three subsets.

The COVID-19 pandemic has resulted in differences regarding the prevalence of aetiologies between our dataset and the subsets of pre-pandemic times. The surge of the frequency of URTI-related olfactory dysfunction may be ascribed to a novel pathomechanism involving sustentacular cells in the olfactory epithelium.

Pediatric Emergency Department (PED) visits nationally decreased while the proportion of injury-related PED visits increased during the COVID-19 pandemic. Little is known about the trends in Rhode Island (RI).

This is a planned sub-analysis of RI data from a retrospective study of pediatric injury-related visits to 40 PEDs for children <18 years old from January 2019-December 2020. We calculated frequencies and compared patient demographics, injury types, severity, and mechanisms for 3/17/2019-12/31/2019 (pre-COVID-19) versus 3/15/2020-12/31/2020 (study period).

Despite a 31.4% decrease in total injury-related PED visits from 2019 to 2020, the proportion of injury-related PED visits increased by 8.1% (p<0.001) in 2020. The mean age of patients decreased from 8.3 (SD 5.4) to 7.7 (SD 5.4) years old (p<0.0001), with a higher proportion of female (p=0.0018), privately insured (p=0.0274), and non-Hispanic White children (p<0.001) in 2020. There was a higher proportion of trauma activations, admissions, and injuries caused by intentional self-harm (all p<0.0001).

In RI, the total number of injury-related PED visits decreased while the proportion of injury-related PED visits increased during the COVID-19 pandemic, similar to national trends. There were significant demographic, mechanism, and intent shifts among injured patients, highlighting epidemiologic changes during the pandemic and identifying high-risk groups that would benefit from targeted education and interventions.

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

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.

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.

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.

Pediatric burn patients are an essential part of burn populations. However, there is limited publicly available data on the epidemiological impact of COVID-19 on pediatric burns in China.

In this paper, pediatric burn patients admitted to the Department of Burn Surgery of the First Hospital of Jilin University before and during COVID-19 were retrospectively investigated to determine the impact of COVID-19 on pediatric burn inpatients.

The information of inpatients from July 2017 to December 2019 (pre-COVID-19 group) and from January 2020 to June 2022 (COVID-19 group) in the Department of Burn Surgery at the First Hospital of Jilin University was retrospectively investigated. Demographic information of patients, length of hospital stay, total body surface area (TBSA) of burn injury, post-injury visit time, comorbidity, surgical methods, etc., were statistically analyzed.

The COVID-19 group included 154 (10.2%) patients, and the pre-COVID-19 group included 335 (19.4%) patients (P＜0.001). There were no differences in gender, age, length of hospital stay, or etiology of burns between the two groups. Compared to the pre-COVID-19 group, patients in the pre-COVID-19 group experienced a significant delay in presentation (P＜0.001), had a larger TBSA of burn wound (P ＜ 0.001), were more prone to sustaining major burns (P ＜ 0.001), a higher likelihood of undergoing operations (P = 0.03), higher cost (P＜0.001) and more complications (P＜0.001). Additionally, upper extremities were the most commonly part involved in both groups (P = 0.004), with the lower extremities showed a significant increase to be involved in burn injury during COVID-19 pandemic (P = 0.007). Furthermore, the majority of guardians did not take first aid measures in both groups following burn injury (P = 0.102).

During the COVID-19 pandemic period, scalds remained the main reason for hospitalization. The number of hospitalized patients has decreased dramatically, while the severity of burns has significantly increased, with a notable delay in hospital visits and an increased occurrence of complications.

Coronavirus disease 2019 disrupted the delivery of public maternal and child health services to caregivers of preschool children, leading to decreased opportunities for injury prevention education. We aim to 1) explore the timing, content, and methods of providing injury prevention information desired by pregnant women and mothers and 2) identify mothers who experienced difficulty in obtaining injury prevention information owing to reduced maternal and child health services.

From March 24 to 29, 2022, we conducted a population-based cross-sectional study and web-based survey. Of the registered monitors of the internet research company Rakuten Insight, 675 mothers raising their first child aged 0-2 during the COVID-19 period (February 2020 to March 2022) were included in the analysis.

Over half of the mothers wanted injury prevention information throughout their pregnancy. They preferred receiving information through traditional face-to-face services provided by local governments, such as antenatal classes or checkups. However, 34.1% of mothers said they did not obtain the information they needed; this was particularly true of unemployed mothers, had children aged 0-1, and had children with illnesses requiring hospital visits.

Mothers who could not obtain injury prevention information were originally disadvantaged mothers concerning access to information. The decrease in maternal and child health services may have widened this information gap. These findings can inform recommendations for caregivers, particularly those susceptible to information gaps during emergencies, and offer insights into future injury prevention education strategies.

The end of 2019 marked the emergence of the COVID-19 pandemic. Public avoidance of health care facilities, including the emergency department (ED), has been noted during prior pandemics.

This study described pandemic-related changes in adult and pediatric ED presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area.

The study was a cross-sectional analysis of ED visits occurring before and during the pandemic. Sites collected daily ED patient census; monthly ED patient acuity, as the Emergency Severity Index (ESI) score; and disposition. Prepandemic ED visits occurring from January 1, 2019 through December 31, 2019 were compared with ED visits occurring during the pandemic from January 1, 2020 through March 31, 2021. The change in prepandemic and pandemic ED volume was found using 7-day moving average of proportions.

The study enrolled 83.8% of the total ED encounters. Pandemic adult and pediatric visit volume decreased to as low as 44.7% (95% CI 43.1-46.3%; p < 0.001) and 22.1% (95% CI 19.3-26.0%; p < 0.001), respectively, of prepandemic volumes. There was also a relative increase in adult and pediatric acuity (ESI level 1-3) and the admission percentage for adult (20.3% vs. 22.9%; p < 0.01) and pediatric (5.1% vs. 5.6%; p < 0.01) populations.

Total adult and pediatric encounters were reduced significantly across a major metropolitan area. Patient acuity and hospitalization rates were relatively increased. The development of strategies for predicting ED avoidance will be important in future pandemics.

This study describes the age-related trends in unintentional injuries in children and adolescents in an urban population 1980-2021. A retrospective study of all children and adolescents aged 0-17 years treated for unintentional injuries at Odense University Hospital, Denmark 1980-2021.

Information about age, gender, place of injury, and diagnoses from the emergency department register. We estimated gender specific annual incidence rates (IRs) in different age groups (0-4, 5-9, 10-14, and 15-17 years) per 1000 population/years. The severity was classified by mild or severe injuries.

Overall, 292,737 unintentionally injured children and adolescents were included. The median age was 10 years and 57.4 % were boys. The overall IR was 241 (CI: 240-242) for boys and 188 (CI: 187-188) for girls per 1000 population/years. In the study period, the overall incidence decreased by 44 % in boys and by 38 % in girls. The overall IR for severe injuries did not change in the study period, whereas the IR of mild injuries decreased significantly in all age groups in both gender. The upper limbs were the most frequently injured in all age groups for both gender, except for children aged 0-4 years, where lesions mostly occurred in the head or neck. In the youngest age groups 0-4 years and 5-9 years wounds were the most common type of lesion, while bruises were the most common type of lesion in the oldest age groups. Fractures accounted for 14.5 % of the lesions with the highest proportions in the 5-9 years and 10-14 years age group.

The study provides information, which is useful when coordinating the resources at emergency departments and for planning preventive campaigns targeting different age groups.

In March 2020, Ontario instituted a lockdown to reduce spread of the SARS-CoV-2 virus. Schools, recreational facilities, and nonessential businesses were closed. Restrictions were eased through 3 distinct stages over a 6-month period (March to September 2020). We aimed to determine the impact of each stage of the COVID-19 public health lockdown on the epidemiology of operative pediatric orthopedic trauma.

A retrospective cohort study was performed comparing emergency department (ED) visits for orthopedic injuries and operatively treated orthopedic injuries at a level 1 pediatric trauma centre during each lockdown stage of the pandemic with caseloads during the same date ranges in 2019 (prepandemic). Further analyses were based on patients' demographic characteristics, injury severity, mechanism of injury, and anatomic location of injury.

Compared with the prepandemic period, ED visits decreased by 20% (1356 v. 1698, p < 0.001) and operative cases by 29% (262 v. 371, p < 0.001). There was a significant decrease in the number of operative cases per day in stage 1 of the lockdown (1.3 v. 2.0, p < 0.001) and in stage 2 (1.7 v. 3.0; p < 0.001), but there was no significant difference in stage 3 (2.4 v. 2.2, p = 0.35). A significant reduction in the number of playground injuries was seen in stage 1 (1 v. 62, p < 0.001) and stage 2 (6 v. 35, p < 0.001), and there was an increase in the number of self-propelled transit injuries (31 v. 10, p = 0.002) during stage 1. In stage 3, all patient demographic characteristics and all characteristics of operatively treated injuries resumed their prepandemic distributions.

Provincial lockdown measures designed to limit the spread of SARS-CoV-2 significantly altered the volume and demographic characteristics of pediatric orthopedic injuries that required operative management. The findings from this study will serve to inform health system planning for future emergency lockdowns.

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.

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.

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.

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.

In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma.

Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP.

We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology.

There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003).

Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.

A relevant number of visits to pediatric emergency departments (pED) are associated with mild traumatic brain injury (mTBI). On March 16, 2020, the Bavarian government declared a first full lockdown (LD) related to the coronavirus (COVID-19) pandemic.

The aim of the study was to investigate the impact of LD on pediatric mTBI.

Retrospective chart review of presentations to a pED due to mTBI. Study periods covered LD (03/17/2020 through 05/05/2020) and the same time in 2017, 2018, and 2019 as reference period (RP). Comparative analyses were performed by Chi-square or Fisher's exact test.

Numbers of mTBI cases decreased by half. Age distribution did not differ. A significantly higher proportion of mTBI were related to falls at home (p = 0.001). Further, a higher rate of hospital admissions (p = 0.03), a higher proportion of intensive care unit admissions (p = 0.001), a longer duration of hospital stay (p = 0.02), and a higher rate of intracranial pathologies on neuroimaging were observed during LD (p = 0.007).

The decrease in mTBI presentations is likely due to an absolute decrease in numbers related to the LD measures, combined with a hesitation to present very minor mTBI to the hospital, because of fear of being infected or not to put additional strain on the healthcare system during this healthcare crisis. On the other hand, data of those that presented with mTBI tend to reflect the more severe spectrum of mTBI.

On March 14, 2020, schools across North Carolina (NC) closed in response to Covid-19, forcing completion of the school year at home. Most pediatric trauma occurs at home with a higher prevalence when children are out of school. We queried the state trauma database to assess if the 2020 "shelter in place" was associated with an increase in pediatric trauma statewide.

The NC trauma database was queried for injuries in children (age < 18 yrs) from 13 March-1 August 2020, and the corresponding months of 2018 and 2019. The number and type of injuries were compared. We also queried the NC death certificate and child welfare databases. Data were analyzed by standard statistical methods using chi-squared or Kruskal-Wallis test.

Total pediatric trauma cases were lower during 2020 (71.6 per 100,000) compared to 2018 (92.4 per 100,000) and 2019 (80 per 100,000) (P < .001); however, average injury severity score (ISS) was higher (P = .001). A significant increase in firearm injuries were seen in 2020 (P = .016), with an increase in mortality (P = .08) and ISS (P = .013). The rate of child abuse trauma decreased in 2020 (P = .005) as did the number of child abuse and neglect reports (P < .001). There were also significant decreases in trauma due to sports, burns, falls, and motor vehicle accidents.

While overall pediatric trauma decreased during the Covid-19 pandemic, there was an alarming increase in penetrating injuries in children. Child abuse trauma and reports decreased, which is concerning for lower identification of abuse.

An international pandemic of severe coronavirus disease (COVID-19) has been caused by the novel coronavirus SARS-CoV-2. A large number of patients with chest trauma were infected with COVID-19. The COVID-19 pandemic had a significant impact on the management of chest trauma.

The present observational study was conducted to evaluate the clinical characteristics and outcomes of chest trauma patients with or without COVID-19 infection.

A multicenter observational study was performed at three Chinese hospitals between November 1, 2022, and January 31, 2023. All enrolled patients were diagnosed with chest trauma. We analyzed data from existing medical records, including all baseline data and prognostic follow-up data, such as 30-day mortality, hospital stays, hospitalization costs, and complications.

All 375 eligible patients completed the follow-up. There was no significant difference in baseline characteristics between chest trauma combined with COVID-19 (p > 0.05). Chest trauma combined with COVID-19 infection may lead to higher 30-day mortality (16.36% vs. 7.14%, p = 0.005), longer hospital stays (22.5 ± 5.9 vs. 12.8 ± 4.2, p < 0.001), larger hospitalization costs (p < 0.001), and increased hospitalization complications, such as pulmonary embolism (10.30% vs. 4.76%, p = 0.039), deep vein thrombosis (DVT, 33.33% vs. 18.57%, p = 0.001), the incidence of 7-day delirium (69.70% vs. 46.19%, p < 0.001), and respiratory failure (38.18% vs. 24.77%, p = 0.005).

Compared to chest trauma alone, it may lead to higher mortality, larger hospitalization costs, and more complications. To better respond to the future of COVID-19 or other similar virus-borne disease pandemics, it is important to understand the clinical characteristics and complications, such as pulmonary embolism, DVT, and respiratory failure after COVID-19 infection. To guide the future treatment of chest trauma combined with COVID-19 infection or other infectious diseases.

The COVID-19 a pandemic changed the world. Public health directives to socially distance with stay-at-home orders altered injury risk factor exposure, resulting injury patterns and conducting injury prevention (IP). The objective of this study was to determine the impact the COVID-19 pandemic on injury and IP at North American trauma centers (TC).

Sixty-two responses were received from pediatric (44%), adult (11%), and combined (31%) TC, from 22 American states, 5 Canadian provinces and Australia. The majority (91%) of programs targeted age groups from birth to 15 years old. Nearly one-third reported IP to be less of an institutional priority with funding redistributed in 15% of centers [median (IQR) - 25% (- 43, 1)], and resultant staffing changes at 38% of centers. A decrease in IP efforts was reported at 64% of TC. Overall, the majority of respondents reviewed injury data, with the top reported increased mechanisms mainly intentional: Firearm-related (75%), assaults (72%), and abuse (71%). Leading increased unintentional injuries were injuries occurring in the home such as falls (70%), followed by ATV (62%), and cycling (57%). Sites pivoted by presenting (74%) or participating (73%) in IP education virtually, social media posts (61%) and the addition of technology (29%). Top barriers were redeployment of partners (45%) and staff (31%), as well as lack of technology (40%) in the target population. Facilitators were technology at TC (74%), support of trauma program (63%), and having IP funding maintained (55%).

Nearly two-thirds of TC decreased IP efforts during the pandemic due to staffing and funding reductions. The leading reported increased injuries were intentional, indicating that violence prevention is needed, along with support for mental health. While TC successfully pivoted by using technology, access issues in the target population was a barrier resulting in health inequities.

The first 2 years of the coronavirus 2019 (COVID-19) pandemic had a profound effect on youth sports participation.

The primary aim of this study was to explore the effect of the COVID-19 pandemic on youth sports injury patterns, with a secondary aim of comparing organized team and individual sport-related injuries in diverse age groups.

Descriptive epidemiology study.

The National Electronic Injury Surveillance System (NEISS) was searched to identify injuries sustained by patients aged 11 to 23 years while playing organized team or individual sports from 2017 to 2021. We investigated reports of concussions, dislocations, fractures, and sprains/strains.

Between 2017 and 2021, there were 58,721 and 3778 team and individual sport-related injuries, respectively. When compared with the prepandemic years, there was a 57.07% decrease in 2020 and 22.31% decrease in 2021 for the number of organized team sport-related injuries. Organized individual sport-related injuries had a 56.24% and 35.18% decrease in number in 2020 and 2021, respectively. Male patients were most likely to be injured in team sports (81.0%), and female patients were most likely to be injured in individual sports (67.1%). High school athletes sustained the majority of injuries in team (57.0%) and individual (51.2%) sports. The years 2020 and 2021 saw a decrease in proportion of sprains/strains and an increase in proportion of fractures.

The number of organized sport-related injuries reported to emergency departments decreased in 2020, and despite vaccinations and easing of social distancing, the 2021 value did not return to what it was prepandemic. As coronavirus-related restrictions have eased, there should be careful monitoring of sports injuries among youth athletes.

Early debridement of childhood burns under sedoanalgesia in the emergency department (ED) may help to reduce the need of surgery and delay in treatment. We performed a retrospective study in burned children who underwent debridement in the ED under sedoanalgesia between March 2020 and December 2020 (COVID group), and were compared with the same months in 2019 (control group). Demographics, burns features, admission rate, and estimated costs associated were collected. A total of 733 children presented at the ED with burns (302 COVID group and 431 control group) without significant differences in burn features between them. Admission rate was significantly lower in COVID group (9.4% vs 19.4%; P < .001), as was the total associated cost for each group ($101 585 vs $209 656; P < .001). The use of sedoanalgesia for the early treatment of pediatric burns in the ED during COVID-19 pandemic is a cost-effective alternative that has reduced the need for hospital admission and associated costs.

Background and Objectives: Restrictions on daily activities to slow down the propagation of COVID-19 have changed the epidemiological pattern of pediatric fractures in many countries. However, the effect of the pandemic on pediatric fractures has not been fully studied. In this study, we investigated the impact of COVID-19 on early adolescent fractures in Korea. Materials and methods: We conducted a retrospective follow-up on a nationwide cohort of Korean early adolescents born between 2006 and 2009. The prevalence and incidence of pediatric fractures and the frequency of surgical treatment were compared between two different eras. Results: The prevalence and incidence of fractures during the pandemic have both shown a significant decrease: prevalence reduced from 34,626 to 24,789 (p < 0.001), while incidence decreased from 29,804 to 18,898 (p < 0.001). Considering sex, the shift in fracture prevalence was statistically significant (p = 0.020), whereas the incidence was not (p = 0.862). The decline in both fracture prevalence and incidence exhibited significant variation across birth year groups (prevalence, p < 0.001; incidence, p < 0.001), with a more pronounced reduction observed in the older age groups. While the proportion of patients who required surgeries has increased, the mean frequency of surgical treatment per patient remained at a similar level (by prevalence, p = 0.181; by incidence, p = 0.735). The decline in both fracture prevalence and incidence has shown significant variation in relation to fracture sites (prevalence, p < 0.001; incidence, p < 0.001), with a decrease in distal limb fractures and an increase in forearm and axial body fractures. Conclusions: The pediatric fracture pattern in Korea has been notably influenced by the COVID-19 pandemic, warranting further investigation into causal factors. Our findings should help predict epidemiology in the post-pandemic period and thus aid policymaking and patient management.

Pediatric trauma epidemiology altered during early COVID-19 pandemic period but the impact of the ongoing pandemic is unknown.

To compare pediatric trauma epidemiology between the pre, early and late pandemic periods and to evaluate the association of race and ethnicity on injury severity during the pandemic.

We performed a retrospective study of trauma consults for an injury/burn in children ≤16 years between January 1, 2019 and December 31, 2021. Study period was categorized into pre (January 1, 2019-February 28, 2020), early (March 1, 2020-December 31, 2020), and late (January 1, 2021-December 31, 2021) pandemic. Demographics, etiology, injury/burn severity, interventions and outcomes were noted.

A total of 4940 patients underwent trauma evaluation. Compared to pre-pandemic, trauma evaluations for injuries and burns increased during both the early (RR: 2.13, 95% CI: 1.6-2.82 and RR: 2.24, 95% CI: 1.39-3.63, respectively) and late pandemic periods (RR: 1.42, 95% CI: 1.09-1.86 and RR: 2.44, 95% CI: 1.55-3.83, respectively). Severe injuries, hospital admissions, operations and death were higher in the early pandemic but reverted to pre-pandemic levels during late pandemic. Non-Hispanic Blacks had an approximately 40% increase in mean ISS during both pandemic periods though they had lower odds of severe injury during both pandemic periods.

Trauma evaluations for injuries and burns increased during the pandemic periods. There was a significant association of race and ethnicity with injury severity which varied with pandemic periods.

Retrospective comparative study, Level III.

Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter.

Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021-two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type.

Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period.

This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency.

Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.

Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.

Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.

During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.

Level III.

Traumatic brain injury (TBI) has a high economic and social impact on the family dynamics, particularly among children. High-quality and comprehensive epidemiological studies about TBI in this population are limited worldwide, specifically in Latin America. Therefore, this study aimed to elucidate the epidemiology of TBI among children in Brazil and its effects on the public health system.

This epidemiological (cohort) retrospective study collected data from the Brazilian healthcare database between 1992 and 2021.

The mean annual volume of hospital admission (HA) due to TBI in Brazil was 29,017. Moreover, the incidence of TBI in the paediatric population was 45.35 admissions per 100,000 inhabitants/year. Furthermore, approximately 941 paediatric hospital deaths per year were caused by TBI, with an in-hospital lethality rate of 3.21%. The average annual financial transfer for TBI was 12,376,628 USD, and the mean cost per admission was 417 USD. In addition, the mean length of hospital stay was 4.2 days. Notably, the length of stay in the hospital was longer among males, Afro-Brazilians patients and individuals aged 15-19 years.

Paediatric TBI is an important public health issue worldwide with high social and economic costs. The incidence of paediatric TBI in Brazil is similar to that in developing countries. Moreover, male predominance (2.3:1) was observed in relation paediatric TBI. Notably, during the pandemic, the incidence of paediatric HA has decreased. To the best of our knowledge, this is the first epidemiological study that specifically evaluates paediatric TBI in Latin America.

Epidemiological data on the use of eye-related emergency services by children are limited. The objective of this study was to determine how COVID-19 affected the epidemiological trends of pediatric ocular emergencies.

We performed a retrospective chart review of children under the age of 18 years who visited our eye-related emergency department between March 17 and June 7, 2020 and between March 18 and June 9, 2019. This was a descriptive and comparative analysis of the two study periods based on the demographic characteristics of patients and the diagnosis reported by the ophthalmologist in the digital medical charts. One of the investigators performed a second reading of the files to homogenize the diagnosis classification based on the most frequently found items.

In total, 754 children were seen in our eye-related emergency department during the 2020 study period versus 1399 in 2019, representing a 46% decrease. In 2019, the four main diagnoses were traumatic injury (30%), allergic conjunctivitis (15%), infectious conjunctivitis (12%), and chalazion/blepharitis (12%). In the 2020 study period there was a significant decrease in the proportion of patients presenting with traumatic injuries (p < 0.001), infectious conjunctivitis (p = 0.03), and chalazion/blepharitis (p < 0.001). Consultations for chalazion/blepharitis were the most affected by the pandemic, followed by traumatic injuries (-72% and -64%, respectively). The proportion of patients who required surgery after trauma was higher in 2020 than in 2019 (p < 0.01), but the absolute number of severe trauma cases remained stable.

The COVID-19 pandemic was accompanied by a decrease in the overall use of a pediatric eye-related emergency services in Paris. Visits due to benign causes and ocular trauma also decreased, but visits for more severe pathologies were not affected. Longer-term epidemiological studies may confirm or refute a change in eye emergency department use habits.

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.

Objective The purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) on injury prevalence in National Collegiate Athletic Association (NCAA) varsity athletes following mandatory state-issued stay-at-home orders in March 2020. A secondary objective was to evaluate the relationship between COVID-19 infection and injury prevalence. Methods The respondents were recruited during pre-participation evaluations held at a Division I university in California in the summer of 2021, as well as via emails shared by athletic trainers at the institution. Data was collected using the Qualtrics Survey Platform (Qualtrics, Provo, UT). For all questions regarding the effects of the COVID-19 pandemic, the participants were asked to compare March 2020-March 2021 ("post-pandemic") to March 2019-March 2020 ("pre-pandemic"). Injury was defined as a physical complaint or condition sustained by an athlete during participation in training or competition that resulted in at least one missed day of practice or competition. The study participants were also asked to disclose their history of laboratory-confirmed COVID-19 infection. Results One hundred forty-six respondents completed the survey, with a 72.3% response rate. Of the respondents, 33.6% (n=49) reported sustaining at least one injury in the year preceding the pandemic, whereas 45.2% (n=66) of respondents reported sustaining at least one injury within the first year of the pandemic, a 34.5% relative increase in injuries (RR=1.35; 95% CI=1.01, 1.80). There was no significant difference in the number of upper body (RR=1.64; 95% CI=0.8, 3.34; p=0.177) versus lower body (RR=1.31; 95% CI=0.94, 1.82; p=0.11) injuries before and after the pandemic onset. Thirty-two respondents reported a history of COVID-19 infection. The athletes who reported a prior COVID-19 diagnosis were no more likely than the athletes with no prior COVID-19 diagnosis to obtain an injury from March 2020 to February 2021 (p=0.85). Conclusion This study indicates that the COVID-19 pandemic and stay-at-home orders were associated with a greater risk of injury in this cohort of collegiate athletes. Interestingly, a history of laboratory-confirmed COVID-19 infection was not associated with increased risk of injury.

To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice.

Systematic review.

Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO).

Children under 18 years.

National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used.

Changes in paediatric emergency care utilisation.

131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively.

The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed.

CRD42021242808.

The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods.

A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0-18 years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018-2019.

A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018-2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries (p = 0.0001) but a significant increase of 14% in burns (p = 0.01) and a 16% increase in bicycle-related injuries (p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed.

There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.

The SARS-CoV-2 (COVID-19) pandemic significantly impacted emergency department volume and acuity. The Delta and Omicron variants contributed to additional surges. We describe the impact that the initial pandemic phase had on frequency and severity of typically non-life-threatening emergencies using upper extremity injuries as a model for other potentially emergent presentation as compared to pre-pandemic times. We do this using the epidemiology of pre-defined significant upper extremity injuries at our facility as a specific example of what occurred at an urban trauma center.

We conducted a comparison of two 6-month periods: between March 2019 and August 2019 (prior to COVID-19) and between March 2020 and August 2020 after the onset of the initial COVID-19 wave. We performed a retrospective chart review of patients who presented with upper extremity injury chief complaints using analysis of the electronic medical record at a single urban tertiary care trauma center in the Midwestern United States. We investigated examination findings, imaging, frequency of surgical procedures and final diagnosis.

In the 2019 study period, there were 31,157 ED patients, including 429 with upper extremity injuries, of which 108 patients had significant injuries. In the 2020 study period, there were 24,295 patient presentations, of which 118 of 296 upper extremity presentations were significant. We a priori defined significant injury as follows: fractures, dislocations, neurovascular injuries, or need for operative intervention within 24 hours of ED presentation. Specifically, 25.2% of injuries were significant pre-COVID-19 and 39.9% (p < 0.001) during the initial COVID-19 surge. The absolute number and percentage of significant injuries increased from pre-COVID-19 compared to the initial COVID-19 surge despite an overall 22% decrease in total patient volume.

The incidence of significant upper extremity musculoskeletal injuries increased during the pandemic even though the overall number of ED presentations for upper extremity musculoskeletal injuries decreased.

The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population.

The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison).

A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant.

Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.

The COVID-19 pandemic and associated behavioural changes have contributed to an increase in substance-related hospital discharges, and has altered the injury epidemiology landscape in Canada. We sought to evaluate hospital discharges for substance-related injuries during the pandemic compared with prepandemic and to identify subpopulations that have been greatly affected by substance-related injuries during the first year of the pandemic.

We compared data on hospital discharges in Canada from before the pandemic (March 2019-February 2020) with discharges during the first year of the pandemic (March 2020-February 2021) using the Discharge Abstract Database. We identified discharges for substance-related injuries using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. We calculated percent changes, age-standardized rates and age-specific rates of discharges for substance-related injuries.

Hospital discharges for substance-related injuries increased by 7.1% during the first year of the pandemic. Discharges for intentional injuries decreased by 6.3%, whereas unintentional substance-related injuries increased by 15.1% during this period. Male patients accounted for 95.6% of the increase in hospital discharges for substance-related injuries during the first year of the pandemic. We observed a percent increase among discharges for injuries related to alcohol, opioid, cannabinoid, hallucinogen, tobacco, volatile solvents, other psychoactive substances and polysubstance use.