1
Trends in accident-related admissions to pediatric intensive care units during
the first COVID-19 lockdown in Germany
Nora Bruns
1
(MD), Lea Willemsen
1
, Katharina Holtkamp
1
, Oliver Kamp
2
(MD), Marcel Dudda
2
(MD), Bernd Kowall
3
(MD), Andreas Stang
3
(MD), Florian Hey
4
(MD), Judith Blankenburg
5
(MD), Sabir Hemmen
6
(MD), Frank Eifinger
7
(MD), Hans Fuchs
8
(MD), Roland Haase
9
(MD),
Clemens Andrée
10
(MD), Michael Heldmann
11
(MD), Jenny Potratz
12
(MD), Daniel Kurz
13
(MD), Anja Schumann
14
(MD), Merle Müller-Knapp
15
(MD), Nadine Mand
16
(MD), Claus
Doerfel
17
(MD), Peter Dahlem
18
(MD), Tobias Rothoeft
19
(MD), Manuel Ohlert
20
(MD), Katrin
Silkenbäumer
21
(MD), Frank Dohle
22
(MD), Fithri Indraswari
23
(MD), Frank Niemann
24
(MD),
Peter Jahn
25
(MD), Michael Merker
26
(MD), Nicole Braun
27
(MD), Francisco Brevis Nunez
28
(MD), Matthias Engler
29
(MD), Konrad Heimann
30
(MD), Gerhard Wolf
31
(MD), Dominik
Wulf
32
(MD), Claudia Hollborn
33
(MD), Holger Freymann
34
(MD), Nicolas Allgaier
35
(MD), Felix
Knirsch
36
(MD), Martin Dercks
37
(MD), Julia Reinhard
38
(MD), Marc Hoppenz
39
(MD), Ursula
Felderhoff-Müser
1
(MD), Christian Dohna-Schwake
1
(MD)
1
Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen,
University of Duisburg-Essen, Essen, Germany
2
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen,
University of Duisburg-Essen, Essen, Germany
3
Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen,
University of Duisburg-Essen, Essen, Germany
4
Pediatric Clinic and Pediatric Polyclinic at the Dr. von Haunerschen Children's Hospital,
Interdisciplinary pediatric intensive care unit - pediatric emergency medicine, LMU Munich,
Munich, Germany
5
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Dresden,
University of Technology Dresden, Dresden, Germany
6
Department of Pediatrics, Neonatology and Pediatric Intensive Care Medicine, University
Hospital Bonn, University of Bonn, Bonn, Germany
7
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Cologne,
University of Cologne, Cologne, Germany
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted August 7, 2021. ; https://doi.org/10.1101/2021.08.06.21261728doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
2
8
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Freiburg,
University of Freiburg, Freiburg, Germany
9
Department of Pediatrics, Neonatology and Pediatric Intensive Care Medicine, University
Hospital Halle, University of Halle, Halle, Germany
10
Department of Pediatrics, Pediatric Intensive Care Medicine, Helios Hospital Krefeld,
Krefeld, Germany
11
Department of Pediatrics, Pediatric Intensive Care Medicine, Helios University Hospital
Wuppertal, Wuppertal, Germany
12
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital
Münster, Münster, Germany
13
Department of Pediatrics 3, Pediatric Cardiology, Pediatric Intensive Care Medicine,
Olgahospital Stuttgart, Stuttgart, Germany
14
Department of Pediatrics, Pediatric Intensive Care Medicine, Schwarzwald-Baar Hospital
Villingen-Schwenningen, Villingen-Schwenningen, Germany
15
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Rostock,
University of Rostock, Rostock, Germany
16
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Marburg,
Philipps University of Marburg, Marburg, Germany
17
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Jena,
University of Jena, Jena, Germany
18
Department of Pediatrics, Pediatric Intensive Care Medicine, Hospital Coburg, Coburg,
Germany
19
Department of Pediatrics, Pediatric Intensive Care Medicine, Catholic Hospital Bochum,
Ruhr-University of Bochum, Bochum, Germany
20
Department of Pediatrics, Pediatric Intensive Care Medicine, Community Hospital Koblenz,
Koblenz, Germany
21
Department of Pediatrics, Pediatric Intensive Care Medicine, Protestant Hospital Bethel,
University of Bielefeld, Bielefeld, Germany
22
Department of Pediatrics, Pediatric Intensive Care Medicine, St. Vinzenz Hospital
Paderborn, Paderborn, Germany
23
Department of Pediatrics, Pediatric Intensive Care Medicine, Hospital Fulda, Fulda,
Germany
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted August 7, 2021. ; https://doi.org/10.1101/2021.08.06.21261728doi: medRxiv preprint
3
24
Department of Pediatrics, Pediatric Intensive Care Medicine, Bergmannsheil and Pediatric
Hospital Buer, Gelsenkirchen, Germany
25
Department of Pediatrics, Pediatric Intensive Care Medicine, Hospital Leverkusen gGmbH,
Leverkusen, Germany
26
Department for Children and Adolescents, Division for Stem Cell Transplantation,
Immunology and Intensive Care Medicine, University Hospital Frankfurt, Goethe University,
Frankfurt am Main, Germany
27
Department of Surgery III, Pediatric Surgery, Ernst von Bergmann Hospital of Potsdam,
Potsdam, Germany
28
Department of Pediatrics, Pediatric Intensive Care Medicine, Sana Hospitals Duisburg,
Duisburg, Germany
29
Department of Pediatrics, Pediatric Intensive Care Medicine, Sana Hospital Offenbach,
Offenbach, Germany
30
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Aachen,
RWTH Aachen University, Aachen, Germany
31
Department of Pediatrics, Pediatric Intensive Care Medicine, Hospital of Traunstein,
Southeast Bavaria Hospitals, Traunstein, Germany
32
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital
Düsseldorf, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
33
Department of Pediatrics, Pediatric Surgery and Pediatric Intensive Care Medicine,
Hospital of Dortmund, Dortmund, Germany
34
Department of Pediatrics, Pediatric Intensive Care Medicine, Florence Nightingale
Hospital, Düsseldorf, Germany
35
Department of Pediatrics, Pediatric Intensive Care Medicine, University Hospital Augsburg,
University of Augsburg, Augsburg, Germany
36
Department of Pediatrics, Pediatric Intensive Care Medicine, Sana Hospital Remscheid,
Remscheid, Germany
37
Department of Pediatrics, Pediatric Intensive Care Medicine, Clemenshospital Münster,
Münster, Germany
38
Department of Pediatrics, Pediatric Intensive Care Medicine, Hospital Mittelbaden, Baden-
Baden, Germany
39
Department of Pediatrics, Pediatric Intensive Care Medicine, Cologne Hospitals, Children’s
Hospital Amsterdamer Str., Cologne, Germany
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted August 7, 2021. ; https://doi.org/10.1101/2021.08.06.21261728doi: medRxiv preprint
4
Corresponding author:
Nora Bruns
University Hospital Essen
Department of Pediatrics I
Hufelandstr. 55
45147 Essen
Phone: +49-201-723-2254
Email: nora.bruns@uk-essen.de
Institutions where the work was performed:
Patient treatment, retrospective identification of cases and extraction of information was
performed in all children’s hospitals mentioned above. Data collection and analysis was
performed at the University Hospital Essen.
Reprints:
No reprints will be ordered.
Financial support:
The study received funding from the Stiftung Universitätsmedizin Essen. NB received funding
from the Medical Faculty of the University of Duisburg-Essen (IFORES program) and from the
Stiftung Universitätsmedizin Essen.
Key words:
accident, trauma, injury, lockdown, pediatric intensive care, COVID-19
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted August 7, 2021. ; https://doi.org/10.1101/2021.08.06.21261728doi: medRxiv preprint
5
Abstract
Objective: To compare the number of accident- and injury-related admissions to pediatric
intensive care units (PICU) during the first German COVID-19 lockdown with previous years.
To investigate if shifts in types of accidents or injuries occurred, especially regarding non-
accidental injuries.
Design: Retrospective observational multicenter study.
Setting: 37 German PICUs.
Patients: 1444 children and adolescents < 18 years admitted to German PICUs due to trauma
or injuries during the first German lockdown period (16.3.-31.5.2020) and during the same
periods of the years 2017-2019.
Interventions: None.
Measurements and main results: Standardized morbidity ratios (SMR) and 95% confidence
intervals (CI) were calculated for the severity of disease, admission reasons, types of accidents,
injury patterns, surgeries and procedures, and outcomes. Disease severity did not differ from
previous years. We found an increase in ingestions (SMR 1.41 (CI 0.88 – 2.16)) and a decrease
in aspirations (0.77 (0.41 – 1.32)) and burns (0.82 (0.59 – 1.12)). The total number of
admissions for trauma remained constant, but traffic accidents (0.76 (0.56 – 1.01) and
school/kindergarten accidents (0.25 (0.05 – 0.74) decreased. Household (1.32 (1.05 – 1.64))
and leisure accidents (1.32 (1.05 – 1.65)) increased. Injured structures did not change, but less
neurosurgeries (0.69 (0.42 – 1.07)) and more visceral surgeries (2.00 (1.14 – 3.24)) were
performed. Non-accidental non-suicidal injuries declined (0.85 (0.50 – 1.37)). Suicide attempts
increased in adolescent boys (1.57 (0.58 – 3.42)), while there was a decrease in adolescent
girls (0.86 (0.53 – 1.31)).
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted August 7, 2021. ; https://doi.org/10.1101/2021.08.06.21261728doi: medRxiv preprint
