Impact of the First COVID Lockdown on Accident- and Injury-Related Pediatric Intensive Care Admissions in Germany—A Multicenter Study

  1. Nora Bruns
  2. Lea Y. Willemsen
  3. Katharina Holtkamp
  4. Oliver Kamp
  5. Marcel Dudda
  6. Bernd Kowall
  7. Andreas Stang
  8. Florian Hey
  9. Judith Blankenburg
  10. Hemmen Sabir
  11. Frank Eifinger
  12. Hans Fuchs
  13. Roland Haase
  14. Clemens Andrée
  15. Michael Heldmann
  16. Jenny Potratz
  17. Daniel Kurz
  18. Anja Schumann
  19. Merle Müller-Knapp
  20. Nadine Mand
  21. Claus Doerfel
  22. Peter Dahlem
  23. Tobias Rothoeft
  24. Manuel Ohlert
  25. Katrin Silkenbäumer
  26. Frank Dohle
  27. Fithri Indraswari
  28. Frank Niemann
  29. Peter Jahn
  30. Michael Merker
  31. Nicole Braun
  32. Francisco Brevis Nunez
  33. Matthias Engler
  34. Konrad Heimann
  35. Gerhard K. Wolf
  36. Dominik Wulf
  37. Saskia Hankel
  38. Holger Freymann
  39. Nicolas Allgaier
  40. Felix Knirsch
  41. Martin Dercks
  42. Julia Reinhard
  43. Marc Hoppenz
  44. Ursula Felderhoff-Müser
  45. Christian Dohna-Schwake

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Abstract

Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.

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  1. Version published to 10.3390/children9030363
  2. ScreenIT

    SciScore for 10.1101/2021.08.06.21261728: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    After the completion of data collection, the raw data were downloaded as a Microsoft Office Excel file and imported into SAS Enterprise Guide 8.4 for statistical analyses.
    Microsoft Office Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    8.4 (SAS Institute Inc.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. The most serious limitation derives from the German hospital system: The indication for hospital and intensive care unit admission is at the discretion of the attending physician. This study is based on the assumption that no fundamental changes in admission practice occurred in German PICUs during the study period. Furthermore, the study is not population-based, even though many hospitals and most German University Hospitals participated. Therefore, our estimates rely on case numbers rather than incidence rates. Some of the hospitals in our study used F codes (behavioral disorders caused by psychotropic substances) for intoxications. This prevented several cases from being included, likely causing an underestimation of the number of intoxications during both study periods (reference and observation period). Even though we collected a considerable number of cases, in-depth analyses were limited due to small case numbers in subgroups. As a further consequence, the small case numbers are sensitive to random fluctuations, thus leaving uncertainty regarding the true strength of effect.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.08.06.21261728v1 on medRxiv