Seasonal variation in musculoskeletal extremity injuries in school children aged 6-12 followed prospectively over 2.5 years: a cohort study

Epidemiological Pattern of Musculoskeletal Injuries in Children Aged 16 Years and Below in a Regional Trauma Centre in Nigeria

Introduction Injuries in children and adults contribute a large percentage to the global burden of disease. Findings in this study will help authorities and governments in our clime to make policies aimed at the prevention and reduction of this burden. Methods This study is a retrospective review of cases of musculoskeletal injuries in children aged 0-16 years seen at the National Orthopaedic Hospital, Lagos, Nigeria, over a period of three years (from January 2017 to December 2019). Results Ninety children were included in this study, made up of 58 males (64.4%) and 32 females (35.4%), presenting a male: female ratio of 1.8:1. The combined average age of the children of both sexes was 8.15+/-4.03 years. The home was the most common place (47.8%) where injuries took place, followed by streets/roads (25.6%). Fall was the commonest etiology/mode of injury (57.8%), followed by traffic accidents (23.3%). The 90 patients studied had 96 injuries, of which 92 (95.8%) were close injuries, and the rest were open injuries. The children sustained 101 fractures of individual bones; the femur was the most frequently fractured bone (36, 35.6%), followed by the humerus (30, 29.7%). Treatment modalities offered included closed reduction with casting, open/closed reduction and K-wire fixation of fractures, wound debridement/care for open injuries, and others. Conclusion Falls and traffic accidents were responsible for most of the injuries in the children studied. Appropriate policies by those in government/authority and the right measures by parents and caregivers will help to reduce the incidence of these largely preventable injuries.

The effect of national public health measures on the characteristics of trauma presentations to a busy paediatric emergency service in Ireland: a longitudinal observational study

BACKGROUND

The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices.

AIMS

The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service.

METHODS

We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1.

RESULTS

There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1.

CONCLUSIONS

This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.

Changes in Orthopaedic diagnoses during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by significant reductions in patient volumes for non-COVID-19-related conditions ranging from acute coronary syndrome to ischemic strokes to acute trauma. However, the impact of the COVID-19 pandemic on patient volumes for a broad range of orthopedic conditions remains unknown. The purpose of this study was to investigate the association of the COVID-19 pandemic with changes in patient volumes of 35 emergent (e.g. dislocations, open fractures), urgent (e.g. fractures), and nonurgent orthopedic conditions (e.g. osteoarthritis, sprains).

METHODS

A retrospective interrupted time-series analysis of patient volumes was conducted for 35 orthopedic conditions based on ICD-10 diagnosis codes. Patient hospitalizations and new problem visits were aggregated across two institutions in New York state, including one urban tertiary care orthopedic hospital, one urban academic medical center, and all state outpatient facilities affiliated with the orthopedic institution. Patient volumes in the COVID-19 peak period (03/2020-05/2020) and COVID-19 recovery period (06/2020-10/2020) were compared against pre-COVID-19 vol (01/2018-02/2020).

RESULTS

Overall, 169,047 cases were included in the analysis across 35 conditions with 3775 emergent cases, 6376 urgent cases, and 158,896 nonurgent cases. During the COVID-19 peak period, patient caseloads for 1 out of 7 emergent conditions (p = 0.02) and 26 out of 28 urgent and nonurgent conditions (p < 0.05) were significantly reduced compared to the pre-COVID-19 period. During the COVID-19 recovery period, patient volumes in 3 out of 13 emergent and urgent conditions (p < 0.03) and 11 out of 22 nonurgent conditions (p < 0.04) were decreased compared to pre-COVID-19 vol.

CONCLUSIONS

This study found that the pandemic was associated with considerable changes in patient patterns for non-COVID-19 orthopedic conditions. The long-term effects of patient volume reductions on both patient outcomes and orthopedic health systems remain to be seen.

LEVEL OF EVIDENCE

Cohort study; level of evidence IV.

Pediatric Hand and Upper Extremity Injuries Presenting to Emergency Departments in the United States: Epidemiology and Health Care-Associated Costs

Background: Upper extremity injuries represent one of the most common pediatric conditions presenting to emergency departments (EDs) in the United States. We aim to describe the epidemiology, trends, and costs of pediatric patients who present to US EDs with upper extremity injuries. Methods: Using the National Emergency Department Sample, we identified all ED encounters by patients aged <18 years associated with a primary diagnosis involving the upper extremity from 2008 to 2012. Patients were divided into 4 groups by age (≤5 years, 6-9 years, 10-13 years, and 14-17 years) and a trauma subgroup. Primary outcomes were prevalence, etiology, and associated charges. Results: In total, 11.7 million ED encounters were identified, and 89.8% had a primary diagnosis involving the upper extremity. Fracture was the most common injury type (28.2%). Dislocations were common in the youngest group (17.7%) but rare in the other 3 (range = 0.8%-1.6%). There were 73.2% of trauma-related visits, most commonly due to falls (29.9%); 96.9% of trauma patients were discharged home from the ED. There were bimodal peaks of incidence in the spring and fall and a nadir in the winter. Emergency department charges of $21.2 billion were generated during the 4 years studied. While volume of visits decreased during the study, associated charges rose by 1.21%. Conclusions: Pediatric upper extremity injuries place burden on the economy of the US health care system. Types of injuries and anticipated payers vary among age groups, and while total yearly visits have decreased over the study period, the average cost of visits has risen.

Using Google Trends to Identify Seasonal Variation in Foot and Ankle Pathology

BACKGROUND

Google Trends proves to be a novel tool to ascertain the level of public interest in pathology and treatments. From anticipating nascent epidemics with data-driven prevention campaigns to identifying interest in cosmetic or bariatric surgery, Google Trends provides physicians real-time insight into the latest consumer trends.

METHODS

We used Google Trends to identify temporal trends and variation in the search volume index of four groups of keywords that assessed practitioner-nomenclature inquiries, in addition to podiatric-specific searches for pain, traumatic injury, and common podiatric pathology over a 10-year period. The Mann-Kendall trend test was used to determine a trend in the series, and the Wilcoxon signed-rank test was used to determine whether there was a significant difference between summer and winter season inquiries. Significance was set at P ≤ .05.

RESULTS

The terms "podiatrist" and "foot doctor" experienced increasing Search Volume Index (SVI) and seasonal variation, whereas the terms "foot surgeon" and "podiatric surgeon" experienced no such increase. "Foot pain," "heel pain," "toe pain," and "ankle pain" experienced a significant increase in SVI, with "foot pain" maintaining the highest SVI at all times. Similar results were seen with the terms "foot fractures," "bunion," "ingrown toenail," and "heel spur." These terms all experienced statistically significant increasing trends; moreover, the SVI was significantly higher in the summer than in the winter for each of these terms.

CONCLUSIONS

The results of this study show the utility in illustrating seasonal variation in Internet interest of pathologies today's podiatrist commonly encounters. By identifying the popularity and seasonal variation of practitioner- and pathology-specific search inquiries, resources can be allocated to effectively address current public inquiries. With this knowledge, providers can learn what podiatric-specific interests are trending in their local communities and market their practice accordingly throughout the year.

COVID-19 Changed the Injury Patterns of Hospitalized Patients

Introduction:

Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years.

Study Objective:

The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years.

Methods:

A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study.

Results:

The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients’ sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital.

Conclusions:

The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.

Impact of the COVID-19 pandemic on the treatment of injuries during lockdown in Norway

AIMS

In order to prevent a major outbreak of COVID-19 disease in Norway, a series of lockdown measures was announced on 12 March 2020. The aim of the present paper was to describe the impact of this lockdown on the treatment of injuries.

METHODS

We collected hospital data on injury diagnoses from a national emergency preparedness register established during the pandemic. We identified the number of injured patients per day in the period 1 January-30 June 2020, and analysed the change in patient volumes over two three-week periods before and during the lockdown by sex, age, level of care, level of urgency, type of contact and type of injury.

RESULTS

Compared to pre-lockdown levels, there was an overall reduction of 43% in injured patients during the first three weeks of lockdown. The decrease in patient contacts did not differ by sex, but was most pronounced among young people. Substantial reductions were observed for both acute and elective treatment and across all levels of care and types of contact, with the exception of indirect patient contacts. The change in patient contacts varied considerably by injury type, with the largest reduction observed for dislocations/sprains/strains. The decrease was much lower for burns/corrosions and poisoning.

CONCLUSIONS

A substantial reduction in the treatment of injuries was observed during lockdown in Norway. Possible explanations for this finding include an overall decrease in injury risk, a redistribution of hospital resources and a higher threshold for seeking medical attention as a result of the pandemic.

Injuries in the time of COVID-19

INTRODUCTION

Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic.

METHODS

Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity.

RESULTS

The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years.

CONCLUSION

As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.

Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019

High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods—methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.

Statement on Methods in Sport Injury Research From the First METHODS MATTER Meeting, Copenhagen, 2019

High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Meeting participants agreed that the definition of sport injury depends on the research question and context. It was considered essential to be explicit about the goal of the research effort and to use frameworks to illustrate the assumptions that underpin measurement and the analytical strategy. Complex systems were discussed to illustrate how potential risk factors can interact in a nonlinear way. This approach is often a useful alternative to identifying single risk factors. Investigating changes in exposure status over time is important when analyzing sport injury etiology, and analyzing recurrent injury, subsequent injury, or injury exacerbation remains challenging. The choice of statistical model should consider the research question, injury measure (eg, prevalence, incidence), type and granularity of injury data (categorical or continuous), and study design. Multidisciplinary collaboration will be a cornerstone for future high-quality sport injury research. Working outside professional silos in a diverse, multidisciplinary team benefits the research process, from the formulation of research questions and designs to the statistical analyses and dissemination of study results in implementation contexts. This article has been copublished in the British Journal of Sports Medicine and the Journal of Orthopaedic & Sports Physical Therapy. J Orthop Sports Phys Ther 2020;50(5):226-233. doi:10.2519/jospt.2020.9876.

Trends in self-reported traumatic brain injury among Canadians, 2005-2014: a repeated cross-sectional analysis

Background:

Concussion and other traumatic brain injuries (TBIs) are a form of unintentional injury that has been associated with both short- and long-term health effects, including possible disability. We investigated time trends in the incidence of all types of injury and TBIs among Canadians, and assessed characteristics of TBIs.

Methods:

We used data from annual cycles of the Canadian Community Health Survey, 2005 to 2014, to examine all types of injury and TBI among Canadians aged 12 years or more. We estimated TBI incidence among respondents who reported any type of injury in the previous year. We used descriptive methods to describe key characteristics (sex, age, season, activity and venue) and 5- and 10-year trends, and generalized linear models to estimate annual percent change in the incidence of all types of injury and TBI.

Results:

The incidence of all types of injury and of TBIs increased between 2005 and 2014, with an annual percent change of 1.4 (95% confidence interval [CI] 0.9-1.9) and 9.6 (95% CI 8.2-11.0), respectively. Sport venues (39.9% [95% CI 32.7-47.1)] and sports-related activities (49.7% [95% CI 42.4-57.0]) were commonly associated with TBIs, and falls were the most frequent mechanism of injury (53.9% [95% CI 46.7-61.0]) leading to a TBI.

Interpretation:

Our findings highlight the increasing trends in all types of injury and TBIs in Canada, and underscore the need for ongoing population level surveillance and targeted prevention efforts to mitigate risk.

Leisure-time sport and overuse injuries of extremities in children age 6-13, a 2.5 years prospective cohort study: the CHAMPS-study DK

OBJECTIVES

It is not known which sports are most likely to cause overuse injuries of the extremities in children. In this study, we report on the incidence of overuse injuries of the upper and lower extremities in children who participate in various leisure-time sports and relate this to the frequency of sport sessions.

DESIGN

Natural experiment including a prospective cohort study.

SETTING

10 state schools in 1 Danish municipality: Svendborg.

PARTICIPANTS

1270 children aged 6-13 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.

OUTCOMES MEASURES

Over 2.5 years, parents answered weekly SMS-track messages (a) on type and frequency of leisure-time sports undertaken by their child, and (b) reporting if their child had experienced any musculoskeletal pain. Children with reported pain were examined by a clinician and diagnosed as having an overuse injury of an extremity or not. The incidence of diagnosed overuse injury was calculated for each of the 9 most common sports in relation to 5-week periods. Incidence by frequency of sessions was calculated, and multivariable analysis was performed taking into account age, sex and frequency of physical education classes at school.

RESULTS

Incidence of overuse injuries of the lower extremity ranged from 0.2 to 3.3 for the 9 sports, but was near 0 for overuse injuries of the upper extremities. There was no obvious dose-response. The multivariate analysis showed soccer and handball to be the sports most likely to result in an overuse injury.

CONCLUSIONS

Among a general population of schoolchildren, overuse injuries of the lower extremities were not common and overuse injuries of the upper extremities were rare. Organised leisure-time sport, as practised in Denmark, can be considered a safe activity for children.

Inflatable bouncer-related injuries to children: increasing phenomenon in pediatric emergency department, 2002-2013

A sharp uptrend in emergency department (ED) visits for injuries associated with inflatable bouncers (IBs) has been observed recently. The aim of this study is to describe the epidemiology and features of injuries resulting from the use of IBs at an Italian pediatric ED. We collected data of 521 children from GIPSE (regional software for management of admission at ED) in the period of 2002-2013. The injuries were slightly more frequent in males than females (52.4 vs 47.6 %). Preschooler children were the most commonly injured (45.7 %). The occurrence of injuries increased by year (eight cases in 2002 and 90 cases in 2013), and a seasonal variability was reported (207 cases in the period of April-June). The most common body region injured was the upper extremity (52.4 %). Children with fractures were 126 times more likely to have injured the upper extremity rather than other body regions compared with patients with no fracture (p < 0.05). Humerus and radius/ulna fractures occurred most commonly in preschooler children (p < 0.05). Fractures were 43 times more likely to be hospitalized than children with no fracture (p < 0.05).

CONCLUSION

Injuries associated with IBs increased over time. Preschooler children were most injured, and this means there is insufficient adherence to existing recommendations concerning an age limit.

WHAT IS KNOWN

• Along with the skyrocketing popularity of IBs among children, the number of children presenting to ED with injuries from these plays has also been increasing at an alarming rate; • The European literature about this phenomenon is scarce and no specific legislations exist for safety of these devises in European Union (EU). What is New: • This is the first study in EU that examines trends for pediatric inflatable bouncer-related injuries at ED over an 11-year period. • Although American Academy of Pediatrics recommends restrictions of attendance to IBs under 6 years old, injuries and fractures continue to occur more frequently under this age.