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

Hanna E. Kläger; Benjamin Nast-Kolb; Lea Reuter; Florian Hoffmann; Sabrina Juranek; Christoph Bidlingmaier; Nicole Fabri; Nils K.T. Schönberg; Johanna Wagner; Florian Heinen; Oliver Muensterer; Christiane Zeller; Anne-Sophie Holler; Alexandra Fröba-Pohl; Michaela V. Bonfert

doi:10.1055/a-2084-2674

Neuropediatrics, Inhaltsverzeichnis

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‡^*

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Benjamin Nast-Kolb‡^*

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Lea Reuter

³Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Florian Hoffmann

³Department of Paediatric Intensive Care and Emergency Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Sabrina Juranek

⁴Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Christoph Bidlingmaier

⁴Department of Pediatric Hemostasis and Thrombosis, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Nicole Fabri

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Nils K.T. Schönberg

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Johanna Wagner

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Florian Heinen

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Oliver Muensterer

⁵Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Christiane Zeller

⁵Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Anne-Sophie Holler

⁵Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Alexandra Fröba-Pohl

⁵Department of Pediatric Surgery, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

,

Michaela V. Bonfert

¹Department of Pediatric Neurology and Developmental Medicine, LMU Hospital, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

²LMU Hospital, Dr. von Hauner Children's Hospital, LMU Center for Children with Medical Complexity, Ludwig-Maximilians-University (LMU), Munich, Germany

› Institutsangaben

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

Volltext

Referenzen

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
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
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
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
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
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
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
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
9 Bayerische Staatsministerien für Gesundheit und Pflege sowie für Familie, Arbeit und Soziales. Az. 51-G8000-2020/122-67. March 16, 2020
10 Bayerisches Staatsministerium für Gesundheit und Pflege. Az. Z6a-G8000-2020/122-98. March 20, 2020
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
12 Rothe K, Fischer B, Degenhardt P. Das Schädel-Hirn-Trauma im Kindesalter. Trauma Berufskrankh 2014; 16 (02) 190-196
13 Tönnis W, Loew F. Einteilung der gedeckten Hirnschädigungen. Arztl Prax 1953; 5: 13-14
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
15 Choe MC. The pathophysiology of concussion. Curr Pain Headache Rep 2016; 20 (06) 42
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
17 McCrory P, Meeuwisse W, Dvořák J. et al. Consensus statement on concussion in sport-the 5^th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51 (11) 838-847
18 Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993; 8 (03) 86-87
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
34 Hon KL, Leung AKC, Torres AR. Concussion: a global perspective. Semin Pediatr Neurol 2019; 30: 117-127

Zusatzmaterial

Supplementary Material