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Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study
Barbara H Chaiyachati1,2,3, Joanne N Wood1,2,3,4, Camille Carter5
1Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine.
Insights
COVID-19 pandemic reduced child physical abuse emergency department encounters, particularly lower-severity cases in young children. Further assessment is needed to determine if this reflects true decreases or decreased recognition of abuse.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse and Neglect Research
- Public Health and Epidemiology
Background:
- The COVID-19 pandemic's impact on child maltreatment in the U.S. remains unclear.
- Pediatric emergency department (ED) encounter trends for child physical abuse offer potential insights.
- This study investigated changes in ED encounters for child physical abuse during the pandemic.
Purpose of the Study:
- To determine the change in the rate of emergency department encounters related to child physical abuse.
- To analyze trends before and during the COVID-19 pandemic.
- To assess variations in encounter rates by clinical severity and age group.
Main Methods:
- Retrospective study using the Pediatric Emergency Care Applied Research Network Registry.
- Identified child physical abuse encounters via diagnosis codes, high-risk injuries, and skeletal surveys.
- Analyzed encounter rates per day and clinical severity before (Jan 2018-Mar 2020) and during (Apr 2020-Mar 2021) the pandemic using Poisson regression.
Main Results:
- Encounter rates for child physical abuse significantly decreased during the pandemic for two of three identification methods.
- Diagnosis-code cohort showed a 19% reduction (aRR: 0.81), with greatest decreases in preschool and school-aged children.
- Injury cohort showed a 10% reduction (aRR: 0.90); lower-severity encounters decreased significantly, while higher-severity encounters did not.
Conclusions:
- Child physical abuse ED encounter rates were reduced or unchanged during the pandemic.
- Reductions were most pronounced in lower-severity cases and among younger children.
- Further critical assessment is required to differentiate true abuse reductions from potential decreases in abuse recognition.
Background And Objective:
The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse.
Methods:
A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018-March 2020) and during the COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods.
Results:
Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not.
Conclusions:
Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.
