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Multicenter Study
. 2022 Aug:276:110-119.
doi: 10.1016/j.jss.2022.02.038. Epub 2022 Feb 24.

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Ruth A Lewit  1 , Meera Kotagal  2 , Vincent P Duron  3 , Richard A Falcone  2 , Logan C Fortenberry  4 , H Michelle Greene  5 , Julie C Leonard  5 , Kathi Makoroff  2 , Devin Midura  3 , Suzanne Moody  6 , Veena Ramaiah  7 , Ankush Gosain  8 , Mark B Slidell  7
Affiliations
Multicenter Study

Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19

Ruth A Lewit et al. J Surg Res. 2022 Aug.

Abstract

Introduction: There has been concern that the incidence of non-accidental trauma (NAT) cases in children would rise during the COVID-19 pandemic due to the combination of social isolation and economic depression. Our goal was to evaluate NAT incidence and severity during the pandemic across multiple US cities.

Methods: Multi-institutional, retrospective cohort study comparing NAT rates in children <18 y old during the COVID-19 pandemic (March-August 2020) with a recent historical data (January 2015-February 2020) and during a previous economic recession (January 2007-December 2011) at level 1 Pediatric Trauma Centers. Comparisons were made in local and national macroeconomic indicators.

Results: Overall rates of NAT during March-August 2020 did not increase compared to historical data (P = 0.8). Severity of injuries did not increase during the pandemic as measured by Glasgow Coma Scale (GCS) (P = 0.97) or mortality (P = 0.7), but Injury Severity Score (ISS) slightly decreased (P = 0.018). Racial differences between time periods were seen, with increased proportions of NAT occurring in African-Americans during the pandemic (P < 0.001). NAT rates over time had low correlation (r = 0.32) with historical averages, suggesting a difference from previous years. Older children (≥3 y) had increased NAT rates during the pandemic. Overall NAT rates had low inverse correlation with unemployment (r = -0.37) and moderate inverse correlation with the stock market (r = -0.6). Significant variation between sites was observed.

Conclusions: Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates.

Keywords: Abuse; COVID-19; Economic; Maltreatment; Non-accidental trauma; Pediatric; Trauma.

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Figures

Fig. 1
Fig. 1
Historical NAT rates and during the COVID-19 pandemic. (A) Historical NAT rates (as cases per trauma admission, %) during the Great Recession of 2008-2009. (B) NAT rates during the COVID-19 pandemic and national unemployment rates (%) and DJIA average closing values (Points) in 2020. HIST = monthly average NAT rate from 2015 to 2019. IQR = interquartile range for 2015-2019. DJIA = Dow Jones Industrial Average.
Fig. 2
Fig. 2
NAT cases and trauma admissions in 2020. NAT cases, trauma admissions, and NAT rates (cases per trauma admission) by site and the entire cohort for 2020. HIST = monthly average NAT rate from 2015 to 2019.
Fig. 3
Fig. 3
NAT rates by age group. NAT rates (as cases per trauma admission, %) by age group for 2020: (A) < 1 y, (B) 1-2 y, (C) ≥ 3 y. HIST = monthly average NAT rate from 2015 to 2019.
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