O2075: Comparative Study of Pediatric Trauma and Fractures Beyond the Peak of COVID-19 Pandemic in New York City

Background: New York City (NYC) was the initial epicenter of the COVID-19 pandemic in the United States. Previous literature has shown a decrease in pediatric trauma and fractures during the pandemic, but few have analyzed those rates beyond the peak of the pandemic. This study aims to assess the epidemiology of pediatric trauma cases in a high-volume teaching hospital in NYC before, during, and after the height of the COVID-19 outbreak.

Methods: After IRB approval, institutional data on pediatric trauma cases from January 1, 2018 to November 30, 2021 were extracted. The following timeframes were studied: I) April 1 to June 22 in 2018 and 2019 (pre-pandemic), II) April 1 to June 22, 2020 (peak pandemic, aligning with the closing and reopening of playgrounds/recreational areas in NYC), and III-VII) trauma cases after June 22, 2020, broken into 3-month intervals ending in November 2021; the latter six were each compared to the respective pre-pandemic period. Groups were compared in terms of patient and trauma characteristics through Chi-squared and t-tests.

Results: Compared to the pre-pandemic cohort (n=7039), peak pandemic trauma cases (n=828) were younger (p < 0.01). Patients were also more likely to initially present to an outpatient office compared to emergency department during the peak pandemic (p < 0.01). During the peak, a greater proportion of trauma cases were fractures (p < 0.01) and both the overall traumas per week rate (p < 0.01) and fractures per week rate significantly decreased (p < 0.01) compared to pre-pandemic. (Table 1) The traumas per week rate has remained lower than the corresponding pre-pandemic rates through at least the end of August 2021. The post-peak pandemic fractures per week rate remained lower than the pre-pandemic rates through June of 2021 until no difference was noted in the July-September 2021 interval. (Figure 1)

Conclusion: It is well established that demand for pediatric trauma care drastically reduced during the height of the COVID-19 pandemic. This study goes further and shows that decreased fracture rates persisted into the 12th month post-pandemic and overall trauma rates have yet to return to pre-pandemic levels. Additionally, more patients initially presented to an outpatient office during the pandemic months, potentially to avoid crowded emergency rooms. This potential fear of COVID-19 may also explain the initial increase in fracture rate immediately after the peak pandemic as patients sought care for injuries sustained during lockdown. This longitudinal analysis helps inform and improve long-term critical care resource allocation in hospital settings for future outbreaks and pandemics. Beyond this, we plan to spatially analyze how trauma and fracture rates changed by zip code to better understand if and how different neighborhoods and populations are variably impacted by the COVID-19 pandemic.