A Multi-institutional Study Evaluating Pediatric Burn Injuries During the COVID-19 Pandemic

Background: During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders, and were potentially unsupervised, increasing their risk for unintentional injury. The objective of this study was to investigate how these events impacted the incidence of burn injuries in children.

Methods: A total of 9 Level I pediatric trauma centers participated in a retrospective study evaluating children <18 years of age with traumatic injuries as defined by the National Trauma Data Bank were included. Patients with burn injuries were defined by ICD-10 Diagnosis and/or External Cause of Injury Codes. Historical controls from March-September 2019 (“Control” cohort) were compared to patients injured after the implementation of the Stay-at-Home Orders from March through September 2020 (“COVID” cohort).

Results: A total of 13,177 pediatric trauma patients were included, of which 987 patients had burn injuries. The total number of children with burn injury increased by 48.6% in 2020, compared to 2019 (COVID cohort 590 patients vs. Control cohort 397 patients; p-value < 0.001), of which 94% was explained by unintentional injury. School aged children accounted for the largest difference in burn injuries between the two cohorts [Table 1]. The average number of burn-injured patients admitted per month increased over time and the difference between 2019 and 2020 peaked in July [Figure 1]. Compared to 2019, the proportion of children sustaining flame burns increased significantly in 2020 (Control 19.1% vs. COVID 26.1%, p=0.0014).

Conclusion: During the COVID-19 pandemic, families experienced unprecedented increased social and financial pressure, and children were out of school for extended periods of time. This time period coincided with a considerable increase in burn injuries. The disproportionate increase in burn injuries in July may reflect the cancellation of professional firework shows across the nation and an increase in amateur pyrotechnicians experimenting with their own fireworks. The onset of the COVID pandemic introduced an extraordinary set of events with unclear consequences.