Impact of the COVID-19 pandemic on pediatric emergency department utilization for head injuries

Head injuries are a leading cause of death and disability in children, accounting for numerous emergency department (ED) visits. It is unclear how the COVID-19 pandemic has influenced healthcare utilization for pediatric head injuries. We hypothesize that the proportion of ED visits attributable to head injury and severity will increase during the COVID-19 era. Retrospective study using electronic health record data to compare proportion and severity of head injury for children 0-21 years of age from three urban mid-Atlantic EDs in the pre-COVID-19 era (March-June 2019) and COVID-19 era (March-June 2020). Controlling for confounders, logistic regression analyses assessed ORs of head injury outcomes. The chi(2) analyses identified differences in patient characteristics. The proportion of head injury visits within the ED population significantly increased during the COVID-19 era (adjusted OR (aOR)=1.2, 95% CI 1.1 to 1.4). Proportion of visits requiring hospitalization for head injury increased by more than twofold in the COVID-19 era (aOR=2.3, 95% CI 1.3 to 4.3). Use of head CT imaging did not significantly change in the COVID-19 era (aOR=1.0, 95% CI 0.7 to 1.6). The proportion of ED visits and hospitalizations for head injury increased during the COVID-19 era. This could be due to changes in the level of supervision and risk exposures in the home that occurred during the pandemic, as well as differences in postinjury care, level of awareness regarding injury severity, and threshold for seeking care, all of which may have influenced pediatric healthcare utilization for head injuries.