Nationwide pediatric injury surveillance across two successive system disruptions in South Korea, 2016-2024.
- 1Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Republic of Korea.
- 2Department of Pediatrics, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. [email protected].
Abstract
Background
Long-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
We 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
Among 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
ED-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.
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BibTeX
@article{han2026nationwide,
title = {{Nationwide pediatric injury surveillance across two successive system disruptions in South Korea, 2016-2024.}},
author = {Sang Il Han and Jeeho Han},
journal = {Injury epidemiology},
year = {2026},
month = aug,
doi = {10.1186/s40621-026-00708-y},
url = {https://europepmc.org/article/MED/43010026},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nationwide pediatric injury surveillance across two successive system disruptions in South Korea, 2016-2024.
AU - Sang Il Han
AU - Jeeho Han
PY - 2026
DA - 2026/08/14
JO - Injury epidemiology
DO - 10.1186/s40621-026-00708-y
UR - https://europepmc.org/article/MED/43010026
AB - Background Long-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 We 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 Among 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 ED-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.
SN - 2197-1714
ER -