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Multicenter Study
. 2022 Jul 1;150(1):e2022056284.
doi: 10.1542/peds.2022-056284.

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

Barbara H Chaiyachati  1   2   3 , Joanne N Wood  1   2   3   4 , Camille Carter  5 , Daniel M Lindberg  6 , Thomas H Chun  7 , Lawrence J Cook  5 , Elizabeth R Alpern  8 ; PECARN Registry Study Group and PECARN Child Abuse Special Interest Group
Affiliations
Multicenter Study

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

Barbara H Chaiyachati et al. Pediatrics. .

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.

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Conflict of interest statement

Conflict of Interest:

Children’s Hospital of Philadelphia has received payment for the expert testimony of Drs. Chaiyachati and Wood when subpoenaed for cases of suspected abuse.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
Average daily encounters per month in pre-pandemic (Jan 2018-March 2020) and pandemic (April 2020 – March 2021) periods. Averages represent non-adjusted total counts across institutions.
See this image and copyright information in PMC

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