A recent study presented at the American College of Surgeons (ACS) Clinical Congress 2023 reveals an alarming increase in injuries among children and teenagers during the COVID-19 pandemic. The research, conducted at Nemours Children’s Health in Delaware, indicates that disadvantaged children residing in socioeconomically disadvantaged neighborhoods are particularly affected by this surge in injuries. The study also highlights the significant impact of adverse social determinants of health (SDOH) on trauma outcomes.
SDOH factors, such as socioeconomic status and crime rates, significantly influence health outcomes, according to the CDC. These factors, including the neighborhood environment, can exacerbate the risk of child injury and negatively affect post-injury outcomes.
The aim of the research was to assess the differences in traumatic injuries in children before and after the COVID-19 pandemic within the context of SDOH. The study analyzed data from over 4,000 trauma patients aged up to 18 years who received treatment at Nemours Children’s Health between January 2018 and August 2022.
Patients were divided into three groups based on the timing of their trauma visits: pre-COVID (before March 11, 2020), early COVID (March 11, 2020 – March 11, 2021), and late COVID (March 12, 2021 – August 31, 2022). The researchers assessed patients’ SDOH risk using the area deprivation index (ADI), which measures factors such as unemployment rates, housing stressors, and income levels in U.S. census block groups.
The study findings revealed a notable increase in injuries caused by motor vehicle crashes and gunshot wounds during the pandemic. Motor vehicle-related injuries increased from 12.7% before COVID-19 to 14.3% in early COVID and 18.6% in late COVID. Gunshot wounds rose from 1.2% pre-COVID to 2.6% early COVID and 2% late COVID.
Furthermore, the researchers discovered that children living in high-deprivation neighborhoods had disproportionately higher rates of injuries compared to those in low-deprivation areas. The high-deprivation group experienced a 5% increase in motor vehicle crashes, a 3.4% increase in non-accidental trauma, and a 2.6% increase in gunshot wounds.
A higher ADI also correlated with longer stays in the intensive care unit and more ventilator days, indicating worse trauma outcomes for disadvantaged children. Dr. Pace, the lead researcher, attributed these outcomes to the severity of injuries, such as motor vehicle and firearm injuries.
The study also highlighted an increase in child abuse injuries, primarily occurring in the high-deprivation group during the early pandemic period. However, other studies have reported a national decrease in child abuse cases during the pandemic, possibly due to reduced reporting as children had limited contact with mandated reporters like teachers and physicians.
Dr. Pace emphasized the need for further research on the effects of the pandemic and SDOH on pediatric trauma. He called for increased preventive efforts from healthcare practitioners, healthcare institutions, and policymakers. Suggestions for prevention included improved emergency preparedness plans, public health initiatives, and policy changes focusing on reducing pediatric trauma and addressing SDOH.
This study adds to the growing evidence that pandemic-related stressors have had a significant impact on population-level health. Dr. Pace emphasized that COVID-19 has caused a substantial socio-political and economic shift across the United States. This study serves as a starting point to identify and address these issues that have arisen during the pandemic.
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1. Source: Coherent Market Insights, Public sources, Desk research
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