The Epidemiology of Pediatric Injuries Related to Recreational Activity During a Global Pandemic

Melissa Blumberg, MD
Wendy J. Pomerantz, MD, MS
Michael A. Gittelman, MD

During the COVID-19 pandemic, families increasingly turned to outdoor activities to socially distance. Recreational equipment sales rose significantly during this time. It is not clear how these changes impacted pediatric injuries. The objective of this study was to investigate changes in the incidence of pediatric emergency department (PED) visits related to outdoor recreational activities during the COVID-19 pandemic versus the preceding 5 years.

This was a single center, retrospective chart review study conducted at a large free standing children’s hospital with a level 1 trauma center. Data were obtained from the PED electronic medical records. Children 5-14 years old with a PED visit from March 23-September 1 in years 2015-2020 with an ICD-10 code for injury associated with recreation and the use of common outdoor recreational equipment (playgrounds, bicycles, ATVs/motorbikes, skateboards/scooters/roller skates/blades, trampolines, and watercraft) were included. Pandemic year, 2020, was compared with the average of pre-pandemic years (2015-2019). Data collected included patient demographics, injury, and disposition. Descriptive statistics were used characterize the population. Chi squared analysis and ANOVA were used to determine relationships between groups.

There were 29044 total injury visits during the study months of which 4712 (16.2%) were due to an included recreational injury. There was a higher proportion of visits related to recreational injury during COVID (8.2%) compared to before (4.9%). Of all study patients, 2771 (58.8%) were male, 3614 (76.6%) were white, 762 (16.2%) were black, 229 (4.9%) were Hispanic, 2668 (56.6%) had private insurance and 627 (13.3%) were admitted to the hospital. Before and during COVID, there were no differences in sex, ethnicity, or ED disposition. During COVID, there was a higher percentage of white patients and patients with commercial insurance injured. There was a significantly lower deprivation index of patients injured in recreation during COVID compared to the mean before COVID. The types of recreational equipment used were significantly different pre- and during COVID with more injuries due to bicycles, ATV/motorbike, wheeled vehicles and fewer due to playground equipment and watercraft during COVID. More injuries occurred in the home compared to at schools and daycares during COVID.

The COVID-19 pandemic has impacted pediatric recreational injuries. The increase in bicycle, ATV/motorbike, and non-motorized wheeled vehicle injuries is consistent with documented sale trends. Closure of parks and limited travel during this time likely contributed to the decrease in playground and water equipment injuries. The cost and access to recreational equipment may explain in higher injury rates in patients with commercial insurance and lower deprivation index during COVID. Further research is needed to determine future prevention efforts to curtail recreational injuries during a pandemic.

1.Demonstrate changes in the proportion and types of ED visits related to recreational injury before and during the pandemic. 2. Discuss the demographics of recreational injury during the pandemic. 3. Review socioeconomic factors that may affect injury patterns