Effect of the COVID-19 pandemic on presentation and severity of traumatic injury due to physical child abuse across US children's hospitals

Abstract

Background: Physical child abuse affects 9 in every 1,000 children in the United States and associated traumatic injuries are often identified by the healthcare system. The COVID-19 pandemic has intensified risk factors for physical child abuse and increased avoidance of the healthcare system. This study examined the effect of the COVID-19 pandemic on presentation and severity of physical child abuse.

Methods: A retrospective, cross-sectional study utilizing the Pediatric Health Information System was performed. An interrupted time series analysis estimated the effect of the COVID-19 pandemic on the number of children <15 years old presenting with physical child abuse to children's hospitals from March 1^st to June 30^th of 2020 by comparing to those presenting during the same period for years 2016-2019. Hierarchical regression models estimated the effect of the pandemic on likelihood of operative intervention, ICU admission, traumatic brain injury, and mortality.

Results: Over the study period, 20,346 physical child abuse encounters were reported by 47 children's hospitals. An interrupted times series model predicted a significant decline in cases due to the effect of the COVID-19 pandemic, representing a deficit of 2,645 cases (p = 0.001). Children presenting during the pandemic had increased odds of requiring ICU admission (p = 0.03) and having a traumatic brain injury in those under 5 years of age (p=<0.001).

Conclusions: The number of children with physical child abuse presenting to children's hospitals significantly declined during the COVID-19 pandemic, but those that did were more likely to be severe. The pandemic may be a risk factor for worse outcomes associated with physical child abuse.

Keywords: COVID-19; Child abuse; Non-accidental trauma in children.

Fig. 1

Interrupted time series model with observed and predicted values, trend, and mean number of cases of physical child abuse in children <15 years old presenting to 47 tertiary children's hospitals each month from March to June from 2016 to 2020. (95% CI = 95% Confidence Interval).

Fig. 2

Sensitivity Analysis: Interrupted time series models with observed and predicted values, trend, and mean number of cases of physical child abuse for A.) children <5 years old and B.) children <15 years old who had an ICD10-CM specific for child abuse (“assault” codes omitted) presenting to 47 tertiary children's hospitals each month from March to June from 2016 to 2020. (95% CI = 95% Confidence Interval, Mar = March, Jun = June).