69 - The Impact of COVID-19 on Fractures Presenting to Pediatric Emergency Departments (EDs)

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 69
Publication Number: 69.112

Stephanie Ruest, Hasbro Children's Hospital at Rhode Island Hospital, Foxboro, MA, United States; Holly R. Hanson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Andrew W.. Kiragu, University of Minnesota/Children's Respiratory & Critical care Specialist's, Minneapolis, MN, United States; Lois K. Lee, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Wendy J. MD, Cincinnati Children's Hospital, Cincinnati, OH, United States

Presenting Author(s)

Stephanie Ruest, MD, MPH, FAAP (she/her/hers)

Assistant Professor of Pediatrics and Emergency Medicine
Hasbro Children's Hospital at Rhode Island Hospital
Foxboro, Massachusetts, United States

Background: Fractures are common and affect nearly 1 in 5 children < 18 years old. Lockdowns and closures due to Covid-19 greatly influenced children’s daily activities and, likely, subsequent injury patterns. Differences in pediatric fracture prevalence and patterns during COVID-19 due to changes in children’s activities are not well understood.

Objective: To examine differences in pediatric fracture prevalence and severity and mechanisms of injury before and during the COVID-19 pandemic.

Design/Methods: This is a sub-analysis of data from a multi-center, cross-sectional study of all injury-related visits to 40 pediatric EDs for children < 18 years old occurring January 2019-December 2020. We analyzed all children with ED visits for fractures identified by ICD10 codes. We calculated frequencies and compared patient demographics, fracture prevalence, severity, and mechanisms of injury for 3/17/2019-12/31/2019 vs. 3/15/2020-12/31/2020 (study period) using the Chi-square statistic.

Results:

Visits for fractures comprised 21.0% of all injury-related visits during the study period (N=123,684), and there were 16,190 fewer visits (-23.2%) in 2020 than in 2019. Fractures of the upper and lower extremities represented 80.8% and 78.4% of visits in 2019 and 2020, respectively. As shown in Table 1, there were significant differences in the proportion of fracture-related visits by age (p< 0.0001), with increases in children < 5 and decreases in children 10-14 years in 2020 vs 2019. In addition, there were significant differences in visits by sex, race, ethnicity, and payor (p< 0.0001, respectively), with a higher proportion of visits in 2020 in females, White children, Non-Hispanic children, and those with private insurance. The patients seen in 2020 with fractures were more severely injured than in 2019, with significantly higher proportions of high acuity ED visits (emergency severity index 1,2 & 3; p< 0.0001), higher injury severity scores (p< 0.0001), a higher admission rate (p< 0.0001) with proportionately more ICU admissions, and more deaths (p=0.007) (Table 2). Fracture mechanisms shifted to proportionately more motor vehicle crashes, bicycles, and firearms in 2020 compared to 2019, p< 0.0001.

Conclusion(s): There was a decrease in fracture-related ED visits during the COVID-19 pandemic but with increases for children < 5 years and more severe injuries. These results can help guide prevention efforts int the event of future pandemics.