Examining Pediatric Injury-Related Emergency Department Vistis During the COVID-19 Pandemic

Examining Pediatric Injury-Related Emergency Department Vistis During the COVID-19 Pandemic 480 320 JoAnna Pendergrass, DVM

During the first year of the COVID-19 pandemic, the frequency of pediatric injury-related visits to the emergency department decreased, while injury severity increased.

The COVID-19 pandemic caused disruptions not only on a global scale but also for individuals, particularly children. Pandemic-related closures of school and extracurricular activities significantly impacted the daily routines of children and their caregivers.

Studies have reported that pediatric injuries increase when children are unsupervised. Pandemic-related closures necessitated children spending more time at home, potentially increasing the amount of unsupervised time.

Jordee Wells, MD, MPH, assistant professor of pediatrics in the Division of Emergency Medicine at Nationwide Children’s Hospital, and her research team performed an epidemiologic analysis of injury-related emergency department (ED) visits during the pandemic for children aged 0 to 17 years.

Their results, recently published in Pediatrics, demonstrated a decrease in these visits and declines in minor injuries (e.g., scrapes, bruises). However, there was an increase in injury severity. “This is important because severe injuries can be life-threatening, result in permanent disability, or both,” Dr. Wells says.

The research team obtained data on pediatric ED visits during the first year of the pandemic (March 15, 2020, to March 14, 2021) from the Pediatric Health Information System for 41 children’s hospitals in the United States.

They divided the first year of the pandemic into three timeframes: early (March 15, 2020, to June 30, 2020), middle (July 1, 2020, to October 31, 2020) and late (November 1, 2020, to March 14, 2021). The team compared data from these time points to data from the three years preceding the pandemic (March 15, 2017, to March 14, 2020).

Data included patient demographics and clinical injury characteristics, such as intentionality and severity.

Data analysis revealed a 26.6% decrease in ED pediatric injury-related visits during the pandemic. Sharp declines were observed in school-age and adolescent children. “Compared with younger children, school-aged and adolescent children experienced a greater disruption in the structure of their lives because of the pandemic, potentially contributing to the sharp decline in injury-related ED visits in this age group,” Dr. Wells explains.

A decrease in ED injury-related visits was also observed in Black, Asian and Hispanic children and children with lower socioeconomic status. Studies have reported that social distancing measures during the pandemic may have caused these marginalized groups to visit the ED less frequently.

The marked increase in serious injuries across each pandemic timeframe was especially concerning. Approximately 60% of these injuries, which included motor vehicle collisions and firearm-related injuries, were unintentional.

Injuries due to suicide intent in children also increased during the pandemic, highlighting the need for accessible mental health and social support services.

“Any increase in severe injuries must remain a priority to investigate and find answers that will inform our strategies to keep children of all ages safe,” Dr. Wells says. Such strategies, she notes, include appropriate adult supervision, motor vehicle safety and childproofing.

As the pandemic continues to affect children’s daily lives, there remains a need to analyze the epidemiology of pediatric injury. “As conditions change through the pandemic, and our responses change, it is important to survey injury types, mechanisms and outcomes and determine if any new patterns emerge that may help improve injury prevention strategies,” Dr. Wells explains.



Wells JM, Rodean J, Cook L, Sills MR, Neuman MI, Kornblith AE, Jain S, Hirsch AW, Goyal MK, Fleegler EW, DeLaroche AM, Aronson PL, Leonard JC. Injury-related pediatric emergency department visits in the first year of COVID-19. Pediatrics. 2022 July 15. doi: 10.1542/peds.2021-054545. Online ahead of print.

Image credit: iStock

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.