Discussions:
The home accidents are the leading preventable accidents in Turkey and in the world. 4 They are frequently seen in the preschool period, leading to disabilities or even death. According to the WHO data, burns, falls, and poisoning are the most common accidents in children younger than 15 and this forms one of the most significant health problems. Previous studies have reported that 18-40% of all accidents in Turkey were the home accidents. 5,6
There is a great deal of responsibility for those who care for children in preventing the home accidents. Considering that preschool-age groups spend more time at home, the home environments should be made safer for this age group. The human factor is critical in the emergence of accidents. Lack of knowledge, negligence, or recklessness is the leading cause of such accidents. Environmental factors (such as building, furniture, or toy safety) also contribute to the home accidents. However, the contribution of global pandemics to the emergence of home accidents is not known.
Since respiratory droplets have been reported to be the transmission route for the disease caused by SARS-CoV-2 (Covid-19), which started at the end of 2019 and spread all over the world in a short period, a number of restrictive measures have been taken in order to prevent crowding and the spread of the disease in communities. The first measure in Turkey was closing educational institutions on March 16, 2020, and moving educational activities to online medium until an unspecified date. Subsequently, the restrictions were further expanded after April 4, 2020, with ”stay at home” orders and curfews for children and adolescents under 20. These restrictions resulted in children and adolescents spending more time at home.
In this period of uncertainties, changes were introduced in the delivery of emergency healthcare services. The number of the patients admitted to the PEDs has decreased in time considerably. It was also noticed that most of the patients came to the hospital with severe clinical conditions. In this context, we analyzed the impact of the ”stay at home” orders with respect to the admissions to PEDs due to the home accidents. Our study indicated that the number of the patients admitted to our PED due to the home accidents during the pandemic period (March – June 2020) was lower than that in the same period of 2019. However, one-fourth of all admissions to the PED were due to the home accidents in this period of 2020 while only one-tenth of all admissions were due to the home accidents in the same period of 2019. In addition, the female/male ratios were similar; the patients in 2020 benefited more from emergency services; falls, foreign bodies in the stomach/intestines, penetrating stab injuries, and cuts were more common in 2020; and there were differences between these periods regarding the diagnostic and the therapeutic procedures. It was also found that the proportion of hospitalized patients was higher in 2020, and these patients were less frequently discharged from the emergency room.
Several studies have demonstrated that the type of the home accidents varied by age. Falls and crashes are the most common types of the home accidents and more frequent in children under the age of five.7,8-12 Falls constitute approximately 30% of trauma admissions and 15% of emergency room admissions 13and are especially common in boys and children under five.14,15-18 Foreign bodies in the esophagus and other parts of the gastrointestinal system are frequent in children between six months and three years. Mortality due to foreign body ingestion is very low. 19-23 In our study, falls were the most common reason for emergency room admissions in the studied period of 2019 and 2020. In our study, falls were more common in children aged five or younger. Falls, foreign bodies in the stomach/intestines, penetrating stab injuries were more common in 2020 than in 2019. The number of admissions to the emergency room was highest in April. Falls were the most common reason for visiting the emergency room in all months of the studied period. A previous study has shown that falls were the most common complaint in all months [24].
Studies have shown that boys are more prone to accidents because they are more active and adventurous than girls. 25-27 On the contrary, our study indicated that girls and boys involved in the home accidents were comparable. However, more girls were admitted between May 1 and June 10, and the proportion of girls admitted to the emergency room increased almost two-folds during the study.
It was interesting that the number of applications for emergency care was highest between 16:00 and 24:00. With the ”stay at home” orders, many institutions implemented flexible or remote working; therefore, a significant portion of the caregivers spent more time at home with their children. It was surprising that the applications to the emergency room were often during these hours.
The rates of recovery or sequelae after home accidents have been reported between 7.8% and 18%. Mortality rates were reported to be between 0% and 2%. 12,28,29 In our study, approximately 90% of the cases in 2019 and approximately 85% of the cases in 2020 were discharged from the emergency room without any sequelae. However, it was found that the cases in 2020 required more hospitalization and intensive care compared to the previous year. This was thought to result from the late admission of these cases or more serious type of accidents and injuries. When all cases were considered, most of the cases presented to the emergency department within the first three hours of the accident. Of three patients, who received intensive care, two had ingested button batteries; one of the patients (10 months old) had melena for three days; the other two patients were admitted to the hospital within three hours of ingesting drugs. The length of hospital stay was similar in both years.