(Kiosk 6) COVID-19 Related Pediatric Amputations- a Case Series

Case Diagnosis: Case series detailing the medical and rehabilitation courses of three pediatric patients that underwent amputations related to COVID-19.

Case Description or Program Description: Pediatric acquired amputations typically occur in the setting of trauma or malignancy. Thus prosthetic fitting and rehabilitation typically have a predictable trajectory. COVID-19 related amputations present new obstacles with many unexpected complicating factors.
This case series highlights 3 patients who developed COVID-19 with the unfortunate complication of lower extremity amputations. We will highlight the variations of their medical courses surrounding initial amputation followed by the challenges in their rehabilitation process and difficulties with follow up care.

Setting: inpatient hospital and rehabilitation unit

Assessment/Results: Each case had a different level of lower extremity amputation with one case requiring bilateral amputations and the other two unilateral. Additionally all three patients had MIS-C, which impacted medical stability and prolonged acute hospital stays prior to transition to inpatient rehabilitation. Their rehabilitation courses varied from pre-prosthetic to prosthetic training. While two were unable to be measured for prosthesis prior due discharge due to wounds, the third patient was fit with a modified IPOP (Immediate Post-Operative Prosthesis) for gait training.
During their inpatient stay observations included:
- many patients were severely deconditioned despite being previously healthy.
- wound complications prolonged prosthetic fitting (only one patient got IPOP in IRU)
- combination of wound healing, deconditioning, social issues contributed to very slow progress with rehabilitation and prosthetic fitting and tolerance.
- consideration of a second rehab stay for true prosthetic training was beneficial to obtain optimal independence

Discussion (relevance): We want to highlight the variations in the circumstances surrounding the initial amputations followed by the challenges in their rehabilitation courses and subsequent care. We hope to spark discussion on how we can best address this new cohort of patients and minimize healthcare disparities in this population.

Conclusions: Ultimately our patient population faced multiple challenges, and in the setting of an unprecedented worldwide pandemic existing problems were magnified and new challenges were faced. We hope to present our experiences to others to allow for faster and more effective care in the future, as well as bring awareness to this unusual patient population.