THE CASE FOR HEIGHTENED CHILD ABUSE SURVEILLANCE DURING COVID-19 LOCKDOWN

Objectives: A literature review was conducted and prior studies regarding non-accidental trauma (NAT) were selected for evaluation. We identified concern for variations in behavior in times of crisis among families, and in subsequent identification of NAT during widespread closure of frequented community services. Due to this concern, we examined our pediatric trauma registry database for all NAT emergency department visits between 2016-2021. We hypothesized that lockdowns and closures would cause a decline in NAT visits to our emergency department during the COVID-19 pandemic with subsequent increase upon lifting these restrictions.

Methods: We examined our pediatric trauma registry database for all NAT emergency department visits between 2016-2021. We evaluated the total number of admissions for each year, and additionally examined the average injury severity score assigned to those patients with physical injuries over 2019-2021.

Results: We found that there was a decline in NAT visits to our emergency department in 2020 (267) from prior years (343 visits average over 2016-2019), with subsequent increase in 2021 (548). We additionally found that there was an increase in average injury severity score (ISS) in 2020 (7.3) when compared to 2019 (5.71), with a decline in average ISS in 2021 (5.42). The total number of cases of reported physical abuse or patients undergoing investigation for physical abuse was increased in 2021 at 92 total patients (increased from 35 and 31 in 2019 and 2020, respectively).

Conclusion: Our data suggests that the COVID-19 pandemic represented a period of increased vulnerability among our pediatric population to NAT, specifically in the setting of widespread closure of many frontline community services. There was a decline in NAT visits during the pandemic in 2020 with a subsequent two-fold increase in 2021 from average NAT visits over 2016-2019. This highlights the potential for missed abuse during closures with increased detection following re-opening. Our data regarding ISS demonstrates the pediatric population is at risk of more severe abuse during times of increased stress and familial hardship. We need increased awareness that periods of vulnerability to NAT exist, as seen during the COVID-19 pandemic. Further attention needs to be paid towards having mechanisms in place to detect NAT in times of increased social, economic, and health strain. Resources should be provided to families during these times to ensure adequate care is given to our pediatric population.