Shifts in pediatric orthopedic injury patterns in the emergency department before, during, and after the COVID-19 pandemic

BACKGROUND: Pediatric orthopedic injuries represent a significant proportion of emergency department (ED) visits and are closely tied to physical activity, particularly organized sports. The COVID-19 pandemic imposed substantial disruptions on children's routines and healthcare utilization, offering a unique opportunity to examine changes in orthopedic injury patterns across different pandemic phases. The objective of the current study was to evaluate temporal shifts in pediatric orthopedic injury characteristics and ED management before, during, and after the COVID-19 pandemic.

METHODS: This retrospective observational study included ED visits from two freestanding pediatric hospitals between January 2019 and December 2023. Patients aged 0-18 years with chief complaints related to upper or lower extremity injuries were analyzed. Demographic, clinical, and ED resource utilization variables were compared across pre-pandemic (2019), pandemic (2020-2021), and post-pandemic (2022-2023) periods using non-parametric statistical tests and trend analyses.

RESULTS: Among 29,777 encounters, orthopedic ED visits declined sharply in 2020, with relative increases in upper extremity and decreases in lower extremity injuries. ED length of stay peaked post-pandemic, and procedural sedation use increased during COVID but became more efficient over time. Imaging use dropped among low-acuity patients in 2020 and rebounded afterward. Public insurance coverage rose, while uninsured rates declined. Racial/ethnic representation also fluctuated during the pandemic.

CONCLUSIONS: The COVID-19 pandemic significantly influenced pediatric orthopedic ED presentations and management. While some trends have normalized, others - such as improved procedural efficiency - suggest enduring shifts in clinical practice. These insights can guide future preparedness and resource planning in pediatric emergency care.