National Epidemiologic Trends and Disparities in Operative Management of Pediatric Facial Soft Tissue Injuries

Introduction: Soft tissue injuries comprise the majority of pediatric facial traumas, yet large-scale epidemiologic studies remain scarce. We present the first national-level analysis of pediatric facial soft tissue injuries in the United States. Methods: A retrospective study of the ACS TQIP (American College of Surgeons Trauma Quality Improvement Project) database from 2017 to 2022 examined 123,558 patients aged 0 to 18 years with facial soft tissue injuries. Patterns before and during COVID-19 were assessed using multivariable regression models. Results: The most prevalent injuries were lacerations, bites, and puncture wounds, with distinct age-related variation. Falls and environmental causes were common in younger children, while older children were disproportionately affected by high-energy trauma mechanisms, such as those from motor vehicle accidents and assaults. Overall, 49.7% received operative treatment. Black children experienced longer surgical delays (9.68±36.1 vs. 7.73±31.2 h for White children, P <0.001). During COVID-19, disparities worsened, with Asian children also experiencing significant delays (13.16±45.5 vs. 7.93±34.1 h for White children, P =0.013). Conclusions: Racial disparities in operative timing worsened during the COVID-19 pandemic, which may compromise long-term functional and aesthetic outcomes in the pediatric face. Our findings highlight the need for timely plastic surgery involvement in anatomically sensitive injuries and standardized referral pathways.