562 - Shifts in Pediatric Orthopedic Injuries: Tracking Trauma Patterns in the Emergency Department Before, During, and After the COVID-19 Pandemic
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 562.6824
Mallory Volz, UCF COM, Orlando, FL, United States; Emily Craver, Mayo Clinic, Jacksonville, FL, United States; Andrea Rivera-Sepulveda, Nemours Children’s Health, Orlando, FL, United States
Physician Nemours Children’s Health Orlando, Florida, United States
Background: The COVID-19 pandemic led to widespread healthcare, economic, and social disruptions. Social distancing measures, lockdowns, school closures, and reduced participation in organized sports have led to changes in children’s activity levels, behaviors, and types of injuries encountered in clinical settings. Objective: To analyze and compare patterns of pediatric orthopedic injuries presented to the emergency department (ED) during the COVID-19 pandemic. Design/Methods: A retrospective cross-sectional study was conducted using data from electronic health records (EHR) from the Nemours Children’s Healthcare System. We included children ages 0 to 18 with upper or lower extremity injuries from January 1, 2019, to December 31, 2023. Groups were divided into pre-pandemic (2019), pandemic (2020-2021), and post-pandemic (2022-2023). Outcomes included resource use per calendar year and temporal distribution of orthopedic injury before, during, and after the pandemic. Spearman test evaluated the strength of associations between variables, and the Cochran-Armitage test examined the significance of a linear trend. Results: We evaluated 35,468 ED visits with orthopedic injuries. Orthopedic injuries declined by 31.3% from 2019 to 2020, but returned to pre-pandemic levels by 2021. There was a significant decrease in lower extremity injuries during the pandemic, from 45.4% to 42.4% (p < 0.001), while upper extremity injuries increased to 58.0% from 54.9% pre-pandemic (p=0.001). Admission rates increased during the pandemic (5.7%) compared to pre-pandemic (4.5%), while discharges declined (p=0.009). Orthopedic injuries during the pandemic showed increased resource use and severity, trending towards higher acuity (p < 0.001). Length of stay increased post-pandemic from 130 to 155 minutes (p < 0.001). While sedation use was highest during the pandemic (13.3%), sedation duration trended downwards post-pandemic (p < 0.001).
Conclusion(s): Pediatric orthopedic injury patterns shifted during the COVID-19 pandemic, with a temporary decline in lower extremity injuries and an increase in upper extremity injuries. Although injury rates returned to pre-pandemic levels by 2021, significant patient management and care changes remain. Understanding these changes in the epidemiology of pediatric orthopedic injuries before, during, and after the pandemic is essential for optimizing emergency department (ED) resources, injury prevention efforts, and pediatric orthopedic care.
