Pediatric sports injury epidemiology during COVID-19 pandemic

Background: The COVID-19 pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports A change in the epidemiology of injuries commonly caused by sporting activities is expected This study seeks to examine the effect of public health measures on the incidence and characteristics of common pediatric sports injuries Methods: This is a retrospective cohort study comparing sporting injuries presenting to a single level I pediatric trauma hospital in the United States during the COVID-19 pandemic to sporting injuries during a pre-pandemic period at the same institution Nine specific injury types were evaluated including ACL injury, meniscus injury, patellar dislocation, osteochondritis dissecans (OCD), shoulder dislocation, ankle sprain, clavicle fracture, medial epicondyle fracture, and tibial spine fracture Patients were included if they presented for initial care between March 15th and April 15th of 2020 for the 'pandemic' group and the same time window in 2018 and 2019 for the 'pre-pandemic' group Results: There were a total of 487 patients included in our study with an average of 222 5 patients in 2018 and 2019 compared to 42 patients in 2020 The average patient age decreased during the pandemic compared to the pre-pandemic period (9 4 ± 6 0 vs 12 4 ± 4 2, p=0 007) as a result of decreased (Table Presented) adolescent aged patients Additionally, a decrease in the proportion of injuries attributed to sports (26 2% vs 47 6%, p=0 005) and those occurring at school/daycare (4 8% vs 10 3%, p<0 001) were observed During the pandemic there was an increase in the proportion of injuries occurring at the patients home (50 0% vs 16 9%, p<0 001)(Table 1) The distribution was significantly different across the nine injury types included with a decrease in the proportion of ankle sprains (31 0% vs 59 8%, p<0 001) and an increase in the proportion of clavicle fractures (50 0% vs 16 2%, p<0 001)(Figure 1) For ankle sprains, there was no significant difference in the proportion of anterior talofibular ligament injuries to high ankle sprains (p=0 898) There was no observed delay in presentation in the 'pandemic' group compared to the 'pre-pandemic' group (6 6 ± 9 6 vs 5 4 ±9 9, p=0 424) Conclusions: At our institution, we observed an over fivefold reduction in presentation for common pediatric musculoskeletal injuries typically associated with sports The dramatic drop off in injuries occurring across both sports and non-sports injury mechanisms raises concern for presentation of untreated injuries in the future Additionally, the increased proportion of injuries occurring in the home setting creates an opportunity for emphasis to be placed on basic safety precautions, especially for young children