Burn visits to a pediatric burn center during the COVID-19 pandemic and 'Stay at home' period.

Dear Sir

Unintentional burns are a leading cause of injury related deaths in young children. Burn visits to the pediatric Emergency Department (ED) pose a significant financial burden on the health care system [1,2]. Low socioeconomic status, young age, parental education, and overcrowding are known risk factors for burns [3]. Our tertiary care pediatric hospital is a burn referral center for our state with historically 600 ED visits and 300 admissions for burn care each year. The COVID-19 pandemic resulted in school and daycare center closures in our state for nearly 10 weeks. We studied the impact of the Stay at Home (SHO) executive order during the COVID-19 pandemic on burn visits in children at our institution.

We analyzed all burn visits to our center by children ≤ 21 years of age between March 16th 2020 and June 3rd 2020 when schools were closed and the “Stay at Home order” (SHO) was executed, and compared this to the same period in 2019 (non SHO). We also collected data on the total number of overall ED visits during the two study periods.

We found a 66.6% reduction in overall ED visits (SHO: 7871 vs non SHO: 23,521) and a 35% reduction in burn visits (SHO: 74 vs non SHO: 114) during SHO period. However, similar to a previous report [4], burn visits contributed to a higher proportion of total ED visits during SHO compared to non SHO (0.94% vs 0.48%, 95% CI: 0.2 to 0.7). We speculate that this increase might have been secondary to closure of most pediatrician offices for direct in-person visits resulting in children presenting to the ED for even minor burns. We found no difference in the mean age between the two study periods (5.3 ± 4.8 vs 4.3 years ± 4.2; difference: 1, 95% CI: 0.3 to -2.3). Scald burns were the most common type of injury during both study periods. However, house fires proportion was significantly higher (16.2% vs 3.5%, 95% CI: 2.9–19.9) during SHO compared to the non SHO period. Although the exact reasons for observed increase in house fires are unclear, potential reasons include loss of social connections and family support, stress of working from home, and lack of structured child care environments with reduced supervision of children. However, further long term studies are indicated to confirm this increase in house fire related burn visits and explore the reasons for the same. The severity of burns was higher during the lockdown as evidenced by an increase in burn alerts (14.8% vs 2.6%, 95% CI: 0.74–17.33), total body surface area (TBSA) burned (2 ± 3.7 vs 3.5 ± 5.5, 95% CI: 0.13–2.86), proportion of children with > 5% TBSA (4.3% vs 13%, 95% CI: 1.09–19.11) and intensive care unit admissions (9.4% v 0.9%, 95% CI: 2.38–17.44). We had one death due to house fire related injury during the SHO period.

Since the majority of pediatric burns occur in the home environment, it may be useful to review fire safety plans with families before any future lockdowns. Parents should be reminded to keep children away from hot liquids and surfaces, installation of a smoke alarms on each level of the house, teaching children to “stop, drop and roll”, and practicing a family evacuation plan.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Contributors

All authors participated in the design of the study. Authors US, AS, LV, CB, DC and NK were involved in data acquisition, statistical analysis and manuscript writing and revisions. Authors US, AS and NK were also involved in data interpretation. Authors CS, LD, JK were involved in study design, data interpretation, writing and critical revisions of the manuscript.

Declaration of conflicts of interest

All authors declare that there are no conflicts of interests