Frequency and type of domestic injuries among children during COVID-19 lockdown: what changes from the past? An Italian multicentre cohort study
Authors: Bezzini Daiana , Lanari Marcello , Amaddeo Alessandro , Aricò Melodie O. , Castagno Emanuele , Cherchi Gabriella , Giacomini Giulia , Graziani Giulia , Grosso Salvatore , Liguoro Ilaria , Lombardi Francesca , Manieri Sergio , Moschettini Laura , Parisi Francesca , Reale Antonino , Romanisio Giulia , Silvagni Davide , Schiavetti Irene ,   “Keep Me Safe” study group, Gaiero Alberto , Iacono Alessandra , Amaddeo Alessandro , Canetto Alessandro , Fachin Alice , Demarco Angela , Lo Sasso Annalisa , Rossetti Annalisa , Reale Antonino , Dagri Arianna , Raffaele Carmela G. , Ghizzi Chiara , Bondone Claudia , Bezzini Daiana , Zama Daniele , Silvagni Davide , Pala Elisa , Pangallo Elisabetta , Castagno Emanuele , Valerio Enrico , Valletta Enrico , Marchetti Federico , Lombardi Francesca , Nicolardi Francesca , Parisi Francesca , Medici Francesco , Silenzi Francesco , Cherchi Gabriella , Ceccarini Giulia , Giacomini Giulia , Graziani Giulia , Romanisio Giulia , Corsini Ilaria , Liguoro Ilaria , Frigo Irene , Raffaldi Irene , Schiavetti Irene , Andreozzi Laura , Moschettini Laura , Penta Laura , Bianchini Luca , Romaniello Luciana , Murciano Manuel , Pagano Manuela , Lanari Marcello , Supino Maria Chiara , Mirauda Maria Pia , Scilipoti Martina , Calvi Matteo , Aricò Melodie O. , Gennari Monia , Della Vecchia Nicoletta , Biban Paolo , Tarlazzi Paolo , Pecoraro Raffaele , Nacca Raffaella , Francavilla Rosa , Lapolla Rosa , Grosso Salvatore , Manieri Sergio , Carlassara Silvia , Ajello Simone , Masi Stefano , Carzaniga Viola 
Published: May 2023

Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3–13 years) receiving a visit in ED during March–June 2019 and March–June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p < 0.001) (IRR: 3.16; p < 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p < 0.001), males (OR: 1.4; p < 0.001), and it increased with age (OR: 1.1; p < 0.001).

    Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home.

What is Known:• In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer.• During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults.

What is New:• During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year.• Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed.