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Impact of "Stay-at-Home" orders on non-accidental trauma: A multi-institutional study
Amelia T Collings1, Manzur Farazi2, Kyle Van Arendonk2
1Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson 125, Indianapolis, IN 46203, United State.
Insights
Stay-at-Home Orders during COVID-19 initially decreased non-accidental trauma (NAT) in children, but rates later increased. The study highlights the need for child protection systems during public health crises.
Area of Science:
- Pediatric trauma
- Public health
- Child welfare
Background:
- The impact of COVID-19 Stay-at-Home Orders (SHO) on child welfare and non-accidental trauma (NAT) rates is not well understood.
- A hypothesis proposed an initial decrease in NAT due to reduced access to mandatory reporters, followed by an increase as services reopened.
Purpose of the Study:
- To investigate the effect of COVID-19 Stay-at-Home Orders on the incidence and characteristics of non-accidental trauma in children.
- To compare NAT rates before and after the implementation of SHO.
Main Methods:
- A multicenter study analyzed patients under 18 with ICD-10 codes for NAT.
- Historical control data (2016-2019) were compared to the "COVID" cohort (March-September 2020).
- Interrupted time series analysis assessed the impact of SHO implementation.
Main Results:
- 2064 NAT cases were identified across nine Level I pediatric trauma centers.
- Initial SHO periods saw NAT rates drop below expected trends, followed by an increase above expected rates.
- The COVID cohort showed a higher proportion of NAT in children aged ≥5 years, minority children, and those with higher social vulnerability index (SVI).
Conclusions:
- The COVID-19 pandemic altered the presentation of pediatric non-accidental trauma.
- Maintaining robust child protection systems is crucial during public health emergencies.
Background:
It is unclear how Stay-at-Home Orders (SHO) of the COVID-19 pandemic impacted the welfare of children and rates of non-accidental trauma (NAT). We hypothesized that NAT would initially decrease during the SHO as children did not have access to mandatory reporters, and then increase as physicians' offices and schools reopened.
Methods:
A multicenter study evaluating patients <18 years with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT. "Historical" controls from an averaged period of March-September 2016-2019 were compared to patients injured March-September 2020, after the implementation of SHO ("COVID" cohort). An interrupted time series analysis was utilized to evaluate the effects of SHO implementation.
Results:
Nine Level I pediatric trauma centers contributed 2064 patients meeting NAT criteria. During initial SHO, NAT rates dropped below what was expected based on historical trends; however, thereafter the rate increased above the expected. The COVID cohort experienced a significant increase in the proportion of NAT patients age ≥5 years, minority children, and least resourced as determined by social vulnerability index (SVI).
Conclusions:
The COVID-19 pandemic affected the presentation of children with NAT to the hospital. In times of public health crisis, maintaining systems of protection for children remain essential.
Level Of Evidence:
III.
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