The Effect of COVID-19 Shelter-in-Place Orders on Pediatric Craniofacial Trauma

Objectives: To investigate the impacts of the shelter-in-place orders on the injury patterns among children with craniofacial trauma.Materials and Methods: Pediatric (<18 years old) craniofacial trauma cases presenting to a regional level I trauma center 1 year before and after the initiation of Washington's shelter-in-place order were retrospectively reviewed. Demographic and injury-related variables were recorded, and bivariate and logistic regression analyses were computed.Results: One hundred nineteen children were evaluated over 2-year period (46 pre- and 73 post-shelter-in-place and were comparable in age, gender, and ethnicity (p >= 0.17)). The distribution of injury mechanisms between pre- and post-shelter-in-place were significantly different (p = 0.02), with the largest proportional increase in falls (10.5%) and had higher rates of associated brain injury (p <= 0.02). After adjusting for effect modifiers and confounders, children presenting during the post-shelter-in-place period were more likely to have associated brain injuries (odds ratio 3.4, 95% confidence interval: 1.11-10.6, p = 0.03).Conclusions: Among pediatric craniofacial injury cases, the shelter-in-place order was associated with a higher likelihood of brain injury and significant changes in injury mechanisms, with a higher proportion of falls.