Changes in pediatric unintentional injury hospitalizations before and after the COVID-19 pandemic: a retrospective analysis.

Objective: This study aimed to analyze the epidemiological characteristics and trends of hospitalizations for unintentional injuries (UI) among children and adolescents (≤18 years) before (2015-2019) and after (2020-2024) the COVID-19 pandemic. Methods: A retrospective review was conducted on 51,591 UI-related hospital admissions from our university-affiliated children's hospital. Patients were categorized into five age groups: infants (<1 year), toddlers (1-3 years), preschool-age (4-6 years), school-age (7-12 years), and adolescents (13-18 years). Data were analyzed across the two defined periods. Results: The total number of UI hospitalizations decreased in Post-COVID compared to pre-COVID. Marked reductions were observed particularly in 2020 and 2022, with a gradual upward trend emerging from 2023 onward-patterns consistent with the evolving impacts of the pandemic. The majority of patients were male and from rural areas throughout the study. However, an increasing yearly trend was observed in the proportion of female patients and those from urban areas after the pandemic. Toddlers consistently had the highest hospitalization rate. A shift in age distribution was noted, with a decreased proportion of cases among infants and toddlers and an increased proportion among school-age children and adolescents post-COVID. Fall/slip were the most common injury mechanism across all ages. Compared with the pre-pandemic period, the proportion of foreign body has decreased significantly in infants, whereas the rate of accidental poisoning has risen markedly among adolescents. Traffic accidents were consistently associated with the highest intensive care unit (ICU) admission rate, the highest readmission rate, and the highest medical costs, yet the lowest rate of recovered/improved. The pattern of body injuries varied with age, with head injuries decreasing and injuries to the extremities, abdomen, and pelvis becoming more common in older age groups. Clinical outcomes improved, with a lower rate of critical illness and higher rates of ICU admission, surgical intervention, and clinical recovered/improved post-COVID. Conclusion: This study delineates the evolving landscape of pediatric UI before and after the COVID-19 pandemic. While the fundamental causes of injury remain, their proportions and severities have shifted, influenced by changes in children's living environments and activities. These results underscore the importance of continuous epidemiological surveillance to inform and refine effective, age-specific prevention strategies and to optimize clinical resource allocation for pediatric injury care.