Shelter in Place and an Alarming Increase in Penetrating Trauma in Children and Concerning Decrease in Child Abuse

Area of Science:

• Pediatric Trauma
• Public Health
• Epidemiology

Background:

• COVID-19 pandemic led to school closures in North Carolina starting March 14, 2020.
• Pediatric trauma has a higher prevalence when children are out of school, often occurring at home.
• The study assessed the impact of the 2020 "shelter in place" order on statewide pediatric trauma.

Purpose of the Study:

• To determine if the 2020 "shelter in place" policy was associated with an increase in pediatric trauma.
• To compare the incidence and types of pediatric injuries before and during the pandemic.
• To analyze trends in child abuse, mortality, and injury severity.

Main Methods:

• Queried the North Carolina (NC) trauma database for pediatric injuries (<18 years) from March 13 to August 1, 2020, and compared with 2018-2019 data.
• Analyzed injury counts, types, and severity scores (ISS) using statistical methods (chi-squared, Kruskal-Wallis).
• Cross-referenced with NC death certificate and child welfare databases.

Main Results:

• Overall pediatric trauma rates decreased in 2020 compared to 2018-2019 (71.6 vs. 92.4/80 per 100,000).
• Average injury severity score (ISS) significantly increased in 2020 (P=.001).
• Firearm injuries significantly increased in 2020 (P=.016), with higher mortality and ISS. Trauma from sports, burns, falls, and MVA decreased. Child abuse trauma and reports also decreased (P=.005).

Conclusions:

• Despite an overall decrease in pediatric trauma during COVID-19, a concerning rise in severe penetrating injuries, particularly from firearms, was observed.
• The decrease in identified child abuse trauma and reports suggests potential under-identification of abuse during the pandemic.
• The findings highlight the complex impact of public health crises on child safety and injury patterns.