A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic
Authors: Hanson Holly R. , Formica Margaret , Laraque-Arena Danielle , Zonfrillo Mark R. , Desai Puja , O’Neil Joseph O. , Unni Purnima , Johnson Estell Lenita , Cobb Patricia , Agarwal Maneesha , Beckworth Kristen , Schroter Stephanie , Strotmeyer Stephen , Donnelly Katie A. , Middelberg Leah K. , Morse Amber M. , Dodington James , Latuska Richard F. , Anderson Brit , Lawson Karla A. , Valente Michael , Levas Michael N. , Kiragu Andrew Waititu , Monroe Kathy , Ruest Stephanie M. , Lee Lois K. , Charyk Stewart Tanya , Attridge Megan M. , Haasz Maya , Jafri Mubeen , McIntire Alicia , Rogers Steven C. , Uspal Neil G. , Blanchard Ashley , Hazeltine Max D. , Riech Teresa , Jennissen Charles , Model Lynn , Fu Quinney , Clukies Lindsay D. , Juang David , Ruda Michelle T. , Prince Jose M. , Chao Stephanie , Yorkgitis Brian K. , Pomerantz Wendy J. 
Published: December 2023

Abstract
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.