How the pandemic spread of COVID-19 affected children's traumatology in Italy: changes of numbers, anatomical locations, and severity.

Background The study aim is to share our experience in hospital re-organization and management of paediatric traumatology in the early stage of COVID-19 pandemic. We centralized paediatric traumatology supposing a reduction of ER admissions, with increased severity of conditions, and a change in fracture patterns and consequently re-organized our structure. The COVID-19 epidemic in Europe has seen Italy as the first focus starting from the 21st of February 2020. Lombardy has been the most affected area. The initial NHS approach determined a high percentage of hospital admissions that led to early overload of hospitals, and we had to reorganize our structure to face the emergency. Methods We retrospectively evaluated the admission and treatment data to observe the epidemiological evolution of paediatric trauma during the lockdown ordinance and compared them with the same period in 2019. Results We found a reduction of 78% paediatric visits in the ER but no decrease in the amount of paediatric fractures, rather we found a rate of paediatric fractures increased by 21,62 %. The upper limb fractures being the most representative. Conclusions Our expectations were confirmed. We believe that the reorganization and the guidelines by us designed has been effective to spare resources and subtract the paediatric traumatology load from those hospitals dealing with an unexpected number of critical COVID-19 patients. Even if we experienced a significant reduction of paediatric admissions to our trauma E.R., the presence of a determined number of fractures justifies the necessity of a specialized hub to collect all paediatric fractures.