Impact of “Stay-at-Home” orders on non-accidental trauma: A multi-institutional study

Evaluating the Regional Differences in Pediatric Injury Patterns During the COVID-19 Pandemic

“…The effect of the pandemic on rates of child abuse varies greatly in the literature, congruent with the differences seen at the site level in this study [ 7 , 14 , 15 , 16 , 17 , 18 ]. Some of the differences can be explained by the differing length in study periods, definitions of child abuse, and inclusion or exclusion of suspected cases of abuse; however, these factors alone do not give the whole picture.…”

“…There have been several reports regarding distinct changes in traumatic injury during this time, including specifically pediatric trauma. Despite several single institutional reports and a small number of multicenter studies, findings are oftentimes discordant [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. While some studies have reported an increase in firearm injuries [ 2 , 5 , 8 , 9 , 10 ], others reported no change [ 3 , 11 ].…”

Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: A multi-institutional analysis

“…While we did not see an increase in the relative proportion of children with an E-Code related to non-accidental trauma, it is important to note there was concern related to the welfare of children in this context and is thus explored in depth elsewhere. 29 All together, these findings highlight the differential effect the COVID pandemic as a whole on injury patterns in children.…”

Socioeconomic Factors and Pediatric Injury

“…Single measures like median income are often used in national databases, including the Agency for Healthcare Research and Quality databases such as Kids’ Inpatient Database (KID) or the National Inpatient Sample (NIS), along with others like the Pediatric Health Information System (PHIS) database. On the other hand, composite indices of socioeconomic deprivation have been used by single institution studies, as well as regional consortiums like the Pediatric Emergency Care Applied Research Network (PECARN) or the Midwest Pediatric Surgical Consortium (MWPSC) [ 6 , 7 •, 8 •]. Single measures may be more intuitive or easier to interpret; for example, it may be simpler to understand the difference in median income between two areas compared to the difference in a deprivation index value.…”

“…Children from socioeconomically disadvantaged backgrounds may also be the most vulnerable to significant changes in external stressors. For example, during the COVID-19 pandemic, both pediatric injury rates overall and rates of CPA increased, but the increased rates of both disproportionately occurred in children from the most vulnerable neighborhoods, as measured by the SVI at the census tract level [ 7 •, 8 •]. Similarly, the burden of firearm injuries as a percentage of all trauma evaluations has increased recently, but this has particularly impacted children from the most socioeconomicaly deprived neighborhoods [ 18 ].…”