Emergency Department Visits Among Adolescents for Intentional Assault, Firearm, Poison, and Self-Harm Injuries Before and During the COVID-19 Pandemic in the United States

Abstract

Purpose This study aimed to examine changes in adolescent emergency department (ED) visits for firearm, poison, self-harm, and intentional assault injuries before and during the COVID-19 pandemic and to identify sociodemographic factors influencing these variations. Methods Utilizing the Nationwide Emergency Department Sample (NEDS), the study analyzes data for intentional self-harm, poison-related, intentional assaults, and firearm injuries from 2019 to 2021 in adolescents aged 10 to 18 years. A difference-in-differences analysis was conducted to investigate the potential impacts of COVID-19 on injury-associated ED visits, accounting for adjustments related to year, patient factors, and hospital characteristics. Results There was a substantial decline in the number of all ED visits from pre-COVID to during the COVID, but we observed increases in the volume of ED visits for firearm-related injuries (13,248 to 20,611; p-value < 0.0001), poison-related injuries (147,812 to 213,753; p-Value < 0.0001), and intentional self-harm-related injuries (153,297 to 229,591; p-value < 0.0001). Conversely, intentional assault-related injuries decreased (167,614 to 154,940; p-value < 0.0001). During the COVID-19 pandemic, ED visits for intentional self-harm increased by 15% (95% CI = 1.09-1.21), intentional assault by 6% (95% CI = 1.02-1.09), and poison-related injuries by 17% (95% CI = 1.11-1.21) compared to pre-pandemic levels. Racial disparities were observed, with Black individuals having lower odds of self-harm (aOR = 0.63) and poison-related visits (aOR = 0.69) but higher odds of assault-related visits (aOR = 1.40) compared to Whites. Hispanic individuals had fewer ED visits across all injury types, while Native Americans had higher odds across all injury types. Disparities between Black and White individuals in assault-related visits narrowed during the pandemic (aOR = 1.40 to 0.94), but disparities for Native Americans in assault-related injuries widened. Insurance status influenced ED visits, with Medicaid recipients having higher odds of self-harm (aOR = 1.11) but lower odds of assault visits (aOR = 0.82) compared to those with private insurance. Uninsured adolescents had lower odds of self-harm (aOR = 0.85) and poison-related visits (aOR = 0.95), but higher odds of assault-related visits (aOR = 1.17). Gender disparities persisted, with females having higher odds of self-harm (aOR = 1.66) and poison-related visits (aOR = 1.42) but lower odds of assault-related visits (aOR = 0.91) compared to males, with these disparities widening for self-harm and poison-related visits during the pandemic. Conclusions The findings underscore the heightened vulnerability of adolescents to certain injuries during the COVID-19 pandemic. Targeted interventions and policies to support mental health, firearm safety measures, and strategies to prevent poisoning are recommended. Addressing socioeconomic disparities is necessary t...