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Neuropediatrics 2023; 54(06): 388-396
DOI: 10.1055/a-2084-2674
Original Article

Trends in Pediatric Mild Traumatic Brain Injury During COVID-19-Related Lockdown—A Single-Center Study

Hanna E. Kläger‡   *
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Benjamin Nast-Kolb‡   *
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Lea Reuter
3   Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Florian Hoffmann
3   Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Sabrina Juranek
4   Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Christoph Bidlingmaier
4   Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Nicole Fabri
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Nils K.T. Schönberg
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Johanna Wagner
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Florian Heinen
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Oliver Muensterer
5   Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Christiane Zeller
5   Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Anne-Sophie Holler
5   Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Alexandra Fröba-Pohl
5   Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
,
Michaela V. Bonfert 
1   Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
2   LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany
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Abstract

Background A relevant number of visits to pediatric emergency departments (pED) are associated with mild traumatic brain injury (mTBI). On March 16, 2020, the Bavarian government declared a first full lockdown (LD) related to the coronavirus (COVID-19) pandemic.

Aim The aim of the study was to investigate the impact of LD on pediatric mTBI.

Methods Retrospective chart review of presentations to a pED due to mTBI. Study periods covered LD (03/17/2020 through 05/05/2020) and the same time in 2017, 2018, and 2019 as reference period (RP). Comparative analyses were performed by Chi-square or Fisher's exact test.

Results Numbers of mTBI cases decreased by half. Age distribution did not differ. A significantly higher proportion of mTBI were related to falls at home (p = 0.001). Further, a higher rate of hospital admissions (p = 0.03), a higher proportion of intensive care unit admissions (p = 0.001), a longer duration of hospital stay (p = 0.02), and a higher rate of intracranial pathologies on neuroimaging were observed during LD (p = 0.007).

Conclusion The decrease in mTBI presentations is likely due to an absolute decrease in numbers related to the LD measures, combined with a hesitation to present very minor mTBI to the hospital, because of fear of being infected or not to put additional strain on the healthcare system during this healthcare crisis. On the other hand, data of those that presented with mTBI tend to reflect the more severe spectrum of mTBI.

Keywords

head injury - mechanisms - symptom patterns - neuroimaging - social distancing

* Those authors equally contributed.


Supplementary Material



Publication History

Received: 07 June 2022

Accepted: 12 April 2023

Accepted Manuscript online:
01 May 2023

Article published online:
26 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ellsäßer G. Unfälle, Gewalt, Selbstverletzung bei Kindern und Jugendlichen 2017. Ergebnisse der amtlichen Statistik zum Verletzungsgeschehen 2014. Fachbericht. Wiesbaden: Statistisches Bundesamt (Federal Statistical Office); April 7, 2017
    Google Scholar
  • 2 Statistisches Bundesamt. Unfälle, Gewalt, Selbstverletzung 2019. Ergebnisse der amtlichen Statistik zum Verletzungsgeschehen 2019. Schwerpunkt: Kinder und Jugendliche. Tabellenband. Wiesbaden: Statistisches Bundesamt (Federal Statistical Office); March 15, 2021
    Google Scholar
  • 3 Dewan MC, Mummareddy N, Wellons III JC, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg 2016; 91: 497-509.e1
    CrossrefPubMedGoogle Scholar
  • 4 Rose SC, Weber KD, Collen JB, Heyer GL. The diagnosis and management of concussion in children and adolescents. Pediatr Neurol 2015; 53 (02) 108-118
    CrossrefPubMedGoogle Scholar
  • 5 Rickels E, von Wild K, Wenzlaff P. Head injury in Germany: a population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas. Brain Inj 2010; 24 (12) 1491-1504
    CrossrefPubMedGoogle Scholar
  • 6 Meehan III WP, Mannix R. Pediatric concussions in United States emergency departments in the years 2002 to 2006. J Pediatr 2010; 157 (06) 889-893
    CrossrefPubMedGoogle Scholar
  • 7 Li Q, Guan X, Wu P. et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
    CrossrefPubMedGoogle Scholar
  • 8 WHO Director-General's opening remarks at the media briefing on COVID19 - 11 March 2020. 2020 . Accessed May 2, 2023 at: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020
    PubMedGoogle Scholar
  • 9 Bayerische Staatsministerien für Gesundheit und Pflege sowie für Familie, Arbeit und Soziales. Az. 51-G8000-2020/122-67. March 16, 2020
    PubMedGoogle Scholar
  • 10 Bayerisches Staatsministerium für Gesundheit und Pflege. Az. Z6a-G8000-2020/122-98. March 20, 2020
    PubMedGoogle Scholar
  • 11 Lumba-Brown A, Yeates KO, Sarmiento K. et al. Centers for disease control and prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr 2018; 172 (11) e182853
    CrossrefPubMedGoogle Scholar
  • 12 Rothe K, Fischer B, Degenhardt P. Das Schädel-Hirn-Trauma im Kindesalter. Trauma Berufskrankh 2014; 16 (02) 190-196
    CrossrefPubMedGoogle Scholar
  • 13 Tönnis W, Loew F. Einteilung der gedeckten Hirnschädigungen. Arztl Prax 1953; 5: 13-14
    PubMedGoogle Scholar
  • 14 Hunt AW, Paniccia M, Reed N, Keightley M. Concussion-like symptoms in child and youth athletes at baseline: what is “typical”?. J Athl Train 2016; 51 (10) 749-757
    CrossrefPubMedGoogle Scholar
  • 15 Choe MC. The pathophysiology of concussion. Curr Pain Headache Rep 2016; 20 (06) 42
    CrossrefPubMedGoogle Scholar
  • 16 Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 36 (43, Suppl): 113-125
    CrossrefPubMedGoogle Scholar
  • 17 McCrory P, Meeuwisse W, Dvořák J. et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51 (11) 838-847
    CrossrefPubMedGoogle Scholar
  • 18 Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993; 8 (03) 86-87
    CrossrefPubMedGoogle Scholar
  • 19 Bram JT, Johnson MA, Magee LC. et al. Where have all the fractures gone? The epidemiology of pediatric fractures during the COVID-19 pandemic. J Pediatr Orthop 2020; 40 (08) 373-379
    CrossrefPubMedGoogle Scholar
  • 20 Baxter I, Hancock G, Clark M. et al. Paediatric orthopaedics in lockdown: a study on the effect of the SARS-Cov-2 pandemic on acute paediatric orthopaedics and trauma. Bone Jt Open 2020; 1 (07) 424-430
    CrossrefPubMedGoogle Scholar
  • 21 Payr S, Schuller A, Dangl T. et al. Maintaining medical resources to treat paediatric injuries during COVID-19 lockdown is essential-an epidemiological analysis of a level 1 trauma centre in central Europe. Int J Environ Res Public Health 2021; 18 (11) 5829
    CrossrefPubMedGoogle Scholar
  • 22 Tschaikowsky T, Becker von Rose A, Consalvo S. et al. Patientenzahlen im Rahmen der COVID-19-Pandemie in einer zentralen Notaufnahme. [Numbers of emergency room patients during the COVID-19 pandemic]. Notf Rettmed 2021; 24 (06) 943-952
    PubMedGoogle Scholar
  • 23 Dopfer C, Wetzke M, Zychlinsky Scharff A. et al. COVID-19 related reduction in pediatric emergency healthcare utilization - a concerning trend. BMC Pediatr 2020; 20 (01) 427
    CrossrefPubMedGoogle Scholar
  • 24 Kruizinga MD, Peeters D, van Veen M. et al. The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature. Eur J Pediatr 2021; 180 (07) 2271-2279
    CrossrefPubMedGoogle Scholar
  • 25 Pinggera D, Klein B, Thomé C, Grassner L. The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown. Eur J Trauma Emerg Surg 2021; 47 (03) 653-658
    CrossrefPubMedGoogle Scholar
  • 26 Rault F, Terrier L, Leclerc A. et al. Decreased number of deaths related to severe traumatic brain injury in intensive care unit during the first lockdown in Normandy: at least one positive side effect of the COVID-19 pandemic. Acta Neurochir (Wien) 2021; 163 (07) 1829-1836
    CrossrefPubMedGoogle Scholar
  • 27 Figueroa JM, Boddu J, Kader M. et al. The effects of lockdown during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on neurotrauma-related hospital admissions. World Neurosurg 2021; 146: e1-e5
    CrossrefPubMedGoogle Scholar
  • 28 Horan J, Duddy JC, Gilmartin B. et al. The impact of COVID-19 on trauma referrals to a National Neurosurgical Centre. Ir J Med Sci 2021; 190 (04) 1281-1293
    CrossrefPubMedGoogle Scholar
  • 29 Jayakumar N, Kennion O, Villabona AR, Paranathala M, Holliman D. Neurosurgical referral patterns during the coronavirus disease 2019 pandemic: a United Kingdom experience. World Neurosurg 2020; 144: e414-e420
    CrossrefPubMedGoogle Scholar
  • 30 Keays G, Friedman D, Gagnon I. Injuries in the time of COVID-19. Health Promot Chronic Dis Prev Can 2020; 40 (11-12) 336-341
    CrossrefPubMedGoogle Scholar
  • 31 Bruns N, Willemsen LY, Holtkamp K. et al. Impact of the first COVID lockdown on accident- and injury-related pediatric intensive care admissions in Germany-a multicenter study. Children (Basel) 2022; 9 (03) 363
    PubMedGoogle Scholar
  • 32 München L. Referat für Bildung und Sport. Wohnortnahe Versorgungsgrade für 0-bis 3-jährige Kinder bzw. 1-bis 3-jährige. 2021 . Accessed May 2, 2023 at: https://stadt.muenchen.de/dam/jcr:58b9586a-41e5-459f-aa51-0e6bf0440be1/Versorgungsgrade_0-3_bzw_1-3_Stadtbezirke%20Sept_21-2.pdf
    PubMedGoogle Scholar
  • 33 Cassidy JD, Carroll LJ, Peloso PM. et al; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 36 (43, Suppl): 28-60
    CrossrefPubMedGoogle Scholar
  • 34 Hon KL, Leung AKC, Torres AR. Concussion: a global perspective. Semin Pediatr Neurol 2019; 30: 117-127
    CrossrefPubMedGoogle Scholar