Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study

Abstract

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.

Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

“…25 Of particular concern were mild cases that might have been able to go undetected during periods of decreased health care use and childcare availability during stay-athome orders. 26,27 Although some studies have supported this claim with a reported increase in the severity of abuse presentations during the pandemic 17 or a disproportionate decrease in mild cases, 19 many others have found no difference. [14][15][16]28 The summer of 2021 coincided with all states reopening their economies, mask mandates being lifted, and the liberalization of gathering limits in the US.…”

“…There is no comprehensive method for determining evolving trends in child maltreatment; however, national administrative data sets provide an opportunity to examine larger patterns created by policy or societal changes and may be useful when examining the effects of COVID-19. Although early reports found an increase in physical abuse during the first few months of the pandemic, there have been several multi-institutional studies spanning longer periods that suggest the opposite . There remains a paucity of data regarding the association of the pandemic on more recent trends in physical abuse.…”

“…Although early reports found an increase in physical abuse during the first few months of the pandemic, [11][12][13] there have been several multi-institutional studies spanning longer periods that suggest the opposite. [14][15][16][17][18][19][20] There remains a paucity of data regarding the association of the pandemic on more recent trends in physical abuse. Therefore, the purpose of this study was to extend the time frame of our previous study 15 that demonstrated a significant decrease in the occurrence of abusive head trauma (AHT) at 44 children's hospitals during the first 5.5 months of the pandemic compared with years prior.…”

COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review

“…Reports from other sources are mixed; violence and abuse hotlines note general increases in call volume ( De Boer et al, 2021 ; Loiseau et al, 2021 ; Petrowski et al, 2021 ; Rapoport et al, 2021 ), whereas emergency department records show more variation with reports of no changes ( Caron et al, 2022b ; Chaiyachati et al, 2022 ; Russell et al, 2020 ), decreases ( Bullinger et al, 2021b ; Chaiyachati et al, 2022 ; Stivaros et al, 2022 ;), as well as increases in both cases ( Amick et al, 2022 ; Bullinger et al, 2021c ; DeLaroche et al, 2021 ; Kovler et al, 2021 ; Loiseau et al, 2021 ; Sidpra et al, 2021 ), and severity of abuse ( De Boer et al, 2021 ). Several studies have also demonstrated a change in the distribution of types of CM, including dramatic increases in admissions related to neglect or lack of supervision ( Bullinger et al, 2021b ), and admissions related to pediatric abusive head trauma since the pandemic onset ( Sidpra et al, 2021 ).…”

Child Abuse Prevention in a Pandemic—A Natural Experiment in Social Welfare Policy

“…Early reports described an uptick in AHT and other forms of serious physical abuse, fueling fears that these cases were canaries in the pandemic coal mine . Subsequent research, however, has largely identified either no change or a reduction in the incidence of—if not the severity of—physical abuse diagnosed in hospital settings . While a complete understanding of the patterns and severity of child abuse over the course of the COVID-19 pandemic will continue to evolve in the coming years, evidence for the anticipated shadow pandemic of child abuse, including AHT, has not emerged.…”