{
  "abstract": "Background\n\nLong-term trends in emergency department (ED)-based pediatric injury surveillance during and after the COVID-19 pandemic remain poorly characterized, particularly in settings that experienced additional system-level disruption. In February 2024, South Korea experienced a second healthcare-system disruption following the mass resignation of trainee physicians from teaching hospitals after a government decision to expand medical school admissions.Methods\n\nWe analyzed National Emergency Department Information System data for children aged under 10 years with injury diagnoses (S00-T79) or external cause codes (V01-Y98), January 2016 to December 2024 (108 months). Monthly ED-recorded injury visit rates were calculated using resident-registration pediatric population denominators. Interrupted time-series analysis used two prespecified breakpoints (COVID-19 onset, March 2020; mass resignation of trainee physicians, February 2024). Recovery Indices compared 2023 with 2018-2019, stratified by resource intensity (KTAS 1-2, ICU, death, or transfer-in) and facility type.Results\n\nAmong 2,783,933 pediatric injury-related ED visits over 9 years, population-adjusted injury contact burden remained incompletely recovered by 2023 (Recovery Index 78.7% after adjusting for a 20.3% pediatric population decline; raw Recovery Index 62.7%), with the transfer-excluded resource-intensity group recovering more completely than the non-resource group (Recovery Index 76.2% vs. 62.3%), suggesting a post-COVID shift in the recorded ED case mix. Regional emergency centers recovered most by 2023 (71.5%) but showed the largest decline at the February 2024 breakpoint (β=-88.7 per 100,000), while non-teaching facilities showed no detectable change (β=+2.4). The level change at the February 2024 breakpoint was - 157.9 per 100,000 (95% CI - 223.7 to - 92.0), against - 183.3 (95% CI - 220.2 to - 146.5) at COVID-19 onset.Conclusions\n\nED-recorded pediatric injury contacts in South Korea remained below pre-pandemic levels, while the recorded case mix showed a relative shift toward more resource-intensive presentations. The 2024 trainee-physician workforce disruption was associated with a second, facility-selective decline that was largest in regional emergency centers and not detectable in other emergency facilities; with 11 months of follow-up these estimates are preliminary. These findings show that pediatric injury surveillance during healthcare-system disruption should not rely on visit counts alone; case mix and facility-tier distribution are needed to interpret ED-recorded injury trends.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Republic of Korea.",
    "Department of Pediatrics, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. mrmaran@naver.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sang Il Han"
    },
    {
      "affs": [
        1
      ],
      "name": "Jeeho Han",
      "orcid": "0000-0002-5388-0836"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/27jg1cn8k7b8w.bib",
  "cited_by": 0,
  "doi": "10.1186/s40621-026-00708-y",
  "fulltext_url": "https://europepmc.org/articles/PMC13753310",
  "id": "27jg1cn8k7b8w",
  "issns": [
    "2197-1714"
  ],
  "landing_url": "https://europepmc.org/article/MED/43010026",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2739|Injury Epidemiology and Prevention"
    ]
  ],
  "openalex": "W7203444394",
  "pdf_url": "https://europepmc.org/articles/PMC13753310?pdf=render",
  "pmcid": "PMC13753310",
  "pmid": "43010026",
  "published": "2026-08-14",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/27jg1cn8k7b8w.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43010026",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43010026"
    },
    {
      "first_seen": "2026-11-15T12:22:28Z",
      "native_id": "PMC13753310",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s40621-026-00708-y"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Injury Epidemiology and Prevention",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Nationwide pediatric injury surveillance across two successive system disruptions in South Korea, 2016-2024.",
  "title_text": "Nationwide pediatric injury surveillance across two successive system disruptions in South Korea, 2016-2024.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-15T12:22:28Z",
  "url": "https://research.draconitic.com/paper/27jg1cn8k7b8w",
  "venue": "Injury epidemiology",
  "versions": []
}