LAUSR

Dear Editor: During the 2020 coronavirus pandemic, most countries in the world have employed social distancing measures to limit the spread of the novel coronavirus SARS-CoV-2 [1]. In their most extreme form, these are colloquially known as “lockdown” and include the prohibition of all but essential travel outside the home and closure of schools. There has been widespread concern amongst the pediatric medical community that these measures might discourage parents from presenting their children to hospital in the event of significant illness. In addition, there has been considerable media speculation that social distancing measures might result in an increase in domestic abuse (in children referred to as non-accidental injury (NAI)) [2]. A considerable proportion of the workload of a pediatric neurosurgery department consists of acute referrals from emergency departments to the “on-call” resident neurosurgeon. We sought to investigate whether a change in referral volume and patterns was observed during the period of socalled lockdown in the UK, with a focus on the pattern of trauma referrals. We carried out a single-centre prospective observational cohort study of all referrals to a regional pediatric neurosurgery unit during the first 6 weeks of the period of extreme social distancing measures in place in the UK during the coronavirus pandemic and compared this to a retrospectively collected, contemporary, seasonally matched control period of the same duration. Inclusion criteria All patients referred to the acute pediatric neurosurgery service between the 23rd of March 2020 and 3rd of May 2020 (“during COVID-19”) and between the 25th of March 2019 and 5th of May 2019 (“pre-COVID19”). Telephone queries about post-operative patients were excluded in order to focus on new presentations only. Baseline demographic data were obtained from the prospectively maintained electronic patient record system. Patients were grouped by referral pathology. Subgroup analysis of trauma referrals was carried out including trauma mechanism and imaging findings. Since our a priori hypothesis was an increase in trauma referrals, we grouped together non-trauma referrals for the purpose of statistical analysis. Unpaired t test was used to compare the mean age in the two comparison groups. The chi-squared test was used to compare proportions of referrals. All statistical tests were performed on Prism 8.0c (GraphPad Software Inc., CA). The study was approved as an audit by the local clinical governance department. In the pre-COVID-19 group, 68 patients (37 M: 31F) aged 5.63 ± 5.66 years (mean ± SD) were referred. In the during COVID-19 group, 78 patients (45M: 33F) aged 4.84 ± 4.91were referred. There was no significance in the gender (p= 0.69) or age (p= 0.37) of patients referred between the two groups. Figure 1 summarises the acute referral pathologies between the two groups. Most acute referrals were trauma-related. There was a non-significant increase in the number of trauma referrals between the cohorts (17 and 27 patients respectively, p = 0.35). Figure 2 summarises the mechanisms of injury encountered and the associated imaging findings. There was no significant difference in any of the trauma mechanisms between the two cohorts. There was a significant increase in the number of trauma patients with intracranial haemorrhagic findings on imaging; however, no significant increase in any one individual subgroup. * Edward W Dyson [email protected]