593 - Child Abuse Rates at a Level 1 Trauma Center are Similar Before and During COVID-19 Pandemic

Periods of economic, social, and physiologic stress have been associated previously with child physical abuse. The COVID-19 pandemic and resultant lockdown led to multifactorial severe stress, leading to concerns that child abuse may occur more frequently during the pandemic.

Objective:

We hypothesized that the rate and severity of child abuse at our Level 1 Trauma center during the pandemic period would be higher as compared to the pre-pandemic period.

Design/Methods:

We performed a retrospective cohort study at Wake Forest Baptist Brenner Children’s ED, an academic Level 1 Trauma Center.  The study included children up to 17 years old who presented for suspected or confirmed physical abuse during the time period of April 2020 to March 2021 during the COVID-19 pandemic and were compared to the time period from April 2018- March 2020. Patient charts were included if the Abuse Screening Tool was positive or if an EMR order for security at bedside was placed.  Charts were manually reviewed and included if the ED Provider documented suspected abuse at time of discharge or during child protection follow up. Patients were excluded who disclosed concern for previous abuse only, patients with concern for sexual abuse only, unintentional injury as a result of neglect, children without any injury found, or cases which were ultimately deemed accidental or low likelihood of abuse after abuse team evaluation.  A two-sample t-test was used to compare the two groups concerning the incidence and injury severity of abuse, with severe defined as 1) required intensive care unit 2) required urgent/emergent surgical intervention and/or 3) had intracranial hemorrhage.

Results:

1,339 charts were selected from March 2018- March 2021 for manual review. The age, gender, and ethnicity of cases of abuse were similar in the two groups. 394 cases met the secondary inclusion criteria and 945 cases were excluded in order of most common occurrence: psychiatric evaluation, accidental injury, neglect, and sexual assault. There was no statistically significant difference in the encounter rate of child abuse in the pandemic period (0.58%) as compared to the pre-pandemic period (0.37%) (p= 0.09). Additionally, there was no difference between the study periods between injury severity (p= 0.48). 

Conclusion(s):

Our center did not have a significant difference in child abuse before and during the pandemic. Our findings are similar to recent large multicenter studies.