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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.
Pediatrics
|June 16, 2022
Summary
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.
