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Published on: December 19, 2020
Child Abuse Imaging and Findings in the Time of COVID-19
M Katherine Henry, Joanne N Wood, Colleen E Bennett
1Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia.
Insights
The COVID-19 pandemic saw a 22% decrease in skeletal surveys for suspected child abuse. However, the rate of occult fractures and injury severity remained unchanged, indicating fewer evaluations, not fewer severe cases.
Area of Science:
- Pediatric radiology
- Child abuse detection
- Public health during pandemics
Background:
- The COVID-19 pandemic altered healthcare access and patient presentation patterns.
- Understanding its impact on the detection of physical abuse in young children is crucial.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on the incidence and characteristics of physical abuse in children under two.
- To compare skeletal survey volume, occult fracture rates, and clinical severity before and during the pandemic.
Main Methods:
- Retrospective analysis of skeletal surveys for suspected physical abuse in children under two.
- Comparison of data from pre-pandemic (March-October 2019) and pandemic (March-October 2020) periods.
- Inclusion criteria: children under 2 years undergoing skeletal surveys due to suspected abuse.
Main Results:
- A 22% decrease in skeletal surveys was observed during the pandemic.
- The percentage of skeletal surveys revealing occult fractures did not significantly change (6.9% vs. 6.4%).
- Clinical severity of presentations and child protective services referrals also decreased during the pandemic.
Conclusions:
- Despite reduced skeletal survey performance during the pandemic, the rate of occult fractures did not increase.
- Findings suggest that the decline in evaluations was not due to fewer severely injured children presenting for care.
- The decrease in medical evaluations for abuse may reflect broader healthcare access issues during the pandemic.
Objective:
To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic: (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase.
Methods:
We conducted a retrospective study of children younger than 2 years undergoing skeletal surveys because of concern for physical abuse at a tertiary children's hospital. Subjects were identified by querying a radiology database during the March 15, 2019-October 15, 2019 (pre-COVID-19) period and the March 15, 2020-October 15, 2020 (COVID-19) period, followed by chart review to refine our population and abstract clinical and imaging data.
Results:
Pre-COVID-19, 160 skeletal surveys were performed meeting the inclusion criteria, compared with 125 during COVID-19, representing a 22% decrease. No change was observed in identification of occult fractures (6.9% pre-COVID vs 6.4% COVID, P = 0.87). Clinical severity of presentation did not change, and child protective services involvement/referral decreased during COVID.
Conclusions:
Despite a >20% decrease in skeletal survey performance early in the pandemic, the percent of skeletal surveys revealing occult fractures did not increase. Our results suggest that decreases in medical evaluations for abuse did not stem from decreased presentation of less severely injured children.
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