Paediatric burns epidemiology during COVID-19 pandemic and 'stay home' era.

Sir,

The COVID-19 pandemic has led to significant changes to society. It has changed the way people behave and how healthcare is provided. In our study, we seek to evaluate the impact of the pandemic on the epidemiology of burns in the paediatric population.

Government-implemented lockdown measures and school closures have led to reduced outdoor activities and lifestyle changes. Our regional Paediatric Burns Centre introduced a new standard operating protocol involving a new phone consultation pathway, a secure email platform for effective communication with parents and tertiary referring hospitals. The aim is to reduce physical attendance to hospital where possible, streamline our referral service, avoid unnecessary admissions and empower parents where appropriate.

We performed a retrospective comparison over five weeks in which the government imposed lockdown instructions from 23/3/2020 to 30/04/2020 (lockdown period) and compared it to a similar period from a year ago 23/03/2019 to 30/04/2019 (control period).

During this period, the total attendance to our Emergency Department (ED) has decreased by 60% in the lockdown period (7127 versus 2936), as expected due to the national advice to avoid unnecessary visits to hospital. The incidence of burn injuries reported was instead greater in proportion — 2.8% of all ED attendances, compared to 1.5% in the previous year, despite the overall decrease in total number of burn injuries (n = 83) by 24%. This could be due to a combination of the closure of some local and minor injury facilities, reduced face-to-face consultations with general practitioners and the advice given to the general public that even minor burn injuries still require medical attention for adequate treatment. This instruction is crucial for the well-known potentially life-threatening complications of burns in children [1]. Concerns were raised by the Royal College of Paediatrics and Child Health that children may be coming to harm from delayed presentation to emergency departments for fears of contracting COVID-19 in hospital. In our cohort of burns patients, only 2 were deemed to have come to harm by delaying presentation.

We also noted that the number of referrals to children social care increased from 4% (5/123) in the control period to 12% (12/95) in the lockdown period. The reduced opportunity to liaise with allied health professionals and education settings to share information and concerns and to finally agree on a plan for follow up might have been due to a more vigilant approach for the fear of missing child protection concerns.

The mean age of patients presenting with burns increased from 2.9 to 4.8 years. School-age children are now spending more time at home due to school closures, and UK statistics have suggested that most burns happen at home [2]. Gender distribution is similar in both periods.

The number of inpatients in our centre decreased by 37%. All patients required COVID-19 testing prior to admission to the ward. During the study period, we did not have any patients who tested positive for COVID-19.

We observed that incidentally more patients were admitted with greater total body surface area (TBSA) burns. During the lockdown period, half of our admissions sustained greater than 5% TBSA burns, with 29% greater than 10% TBSA. In our control period, 95% of all admissions sustained a burn equal or lesser than 5% TBSA. The duration of stay has also halved, with length of stay/TBSA (LOS/TBSA) being 0.42 during the lockdown period compared to 1.04 in the control period. This suggests that we are managing bigger burns as outpatients in the lockdown period.

Scald injuries remain the commonest cause of paediatric burn injuries (85% in the lockdown period, 68% in the control period). Recently, our centre observed a surge in scalds directly resulting from the practice of steam inhalation during the COVID-19 pandemic, as an unprescribed method to prevent and treat infection [3].

Forty-one patients were followed up as outpatients in lockdown compared to 48 patients in the control period. Only 39% of patients had to physically attend for clinical review, opposed to 100% in the control period. The introduction of a new teleconsultation system is helping empower parents to look after their children who have sustained burn injuries, which also reduces the need for physical attendance.

At present, it is not yet possible to ascertain the impact of the pandemic on the long-term outlook of paediatric burn injuries. Continual effort and research into the subject is essential for us to better comprehend the lasting effects of this new phenomenon, to plan our services and protect the wellbeing of children.

Declarations of interest

None.