Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study
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 encount...
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| Veröffentlicht in: | Pediatrics (Evanston) 2022-07, Vol.150 (1), p.18 |
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| creator | Chaiyachati, Barbara H Wood, Joanne N Carter, Camille Lindberg, Daniel M Chun, Thomas H Cook, Lawrence J Alpern, Elizabeth R |
| description | 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.
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.
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 |
| doi_str_mv | 10.1542/peds.2022-056284 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0031-4005</identifier><identifier>ISSN: 1098-4275</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2022-056284</identifier><identifier>PMID: 35707943</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Child ; Child abuse & neglect ; Child Abuse - diagnosis ; Child, Preschool ; Children ; Confidence intervals ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; Emergency medical care ; Emergency Service, Hospital ; Humans ; Pandemics ; Pediatrics ; Regression analysis ; Retrospective Studies ; United States - epidemiology</subject><ispartof>Pediatrics (Evanston), 2022-07, Vol.150 (1), p.18</ispartof><rights>Copyright © 2022 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Jul 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-d1e1c1ecff9971c619dd4750971d126712a7429aac0432bd1ba3a0e9305d84453</citedby><cites>FETCH-LOGICAL-c383t-d1e1c1ecff9971c619dd4750971d126712a7429aac0432bd1ba3a0e9305d84453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35707943$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaiyachati, Barbara H</creatorcontrib><creatorcontrib>Wood, Joanne N</creatorcontrib><creatorcontrib>Carter, Camille</creatorcontrib><creatorcontrib>Lindberg, Daniel M</creatorcontrib><creatorcontrib>Chun, Thomas H</creatorcontrib><creatorcontrib>Cook, Lawrence J</creatorcontrib><creatorcontrib>Alpern, Elizabeth R</creatorcontrib><creatorcontrib>PECARN Registry Study Group and PECARN Child Abuse Special Interest Group</creatorcontrib><title>Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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.
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.
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.
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.</description><subject>Child</subject><subject>Child abuse & neglect</subject><subject>Child Abuse - diagnosis</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Confidence intervals</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Humans</subject><subject>Pandemics</subject><subject>Pediatrics</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><issn>0031-4005</issn><issn>1098-4275</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtrGzEUhUVpaZyk-66KoJtsxr16jUbdFGM7D3AIIWm3QpZkZ8w8HGlk8L-PjNPQZiUuOudw7v0Q-kpgTASnP7bexTEFSgsQJa34BzQioKqCUyk-ohEAIwUHECfoNMYNAHAh6Wd0woQEqTgboft568Pad3aPZ35rwtD6bsDTp7pxeLJM0eP5zjTJDHXfRTxLoe7WeHr352ZWEPUTT_BtaobaZpMP-GFIbn-OPq1ME_2X1_cM_b6cP06vi8Xd1c10sigsq9hQOOKJJd6uVkpJYkuinONSQB4coaUk1EhOlTEWOKNLR5aGGfCKgXAV54KdoV_H3G1att4dKgTT6G2oWxP2uje1_v-nq5_0ut_pfCEuWSlzwsVrQuifk4-DbutofdOYzvcp6txCCsmrimXp93fSTZ9Cl_fLqoqXXOWLZhUcVTb0MQa_emtDQB-A6QMwfQCmj8Cy5du_W7wZ_hJiL74ikIs</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Chaiyachati, Barbara H</creator><creator>Wood, Joanne N</creator><creator>Carter, Camille</creator><creator>Lindberg, Daniel M</creator><creator>Chun, Thomas H</creator><creator>Cook, Lawrence J</creator><creator>Alpern, Elizabeth R</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220701</creationdate><title>Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study</title><author>Chaiyachati, Barbara H ; Wood, Joanne N ; Carter, Camille ; Lindberg, Daniel M ; Chun, Thomas H ; Cook, Lawrence J ; Alpern, Elizabeth R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-d1e1c1ecff9971c619dd4750971d126712a7429aac0432bd1ba3a0e9305d84453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Child</topic><topic>Child abuse & neglect</topic><topic>Child Abuse - diagnosis</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Confidence intervals</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Humans</topic><topic>Pandemics</topic><topic>Pediatrics</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaiyachati, Barbara H</creatorcontrib><creatorcontrib>Wood, Joanne N</creatorcontrib><creatorcontrib>Carter, Camille</creatorcontrib><creatorcontrib>Lindberg, Daniel M</creatorcontrib><creatorcontrib>Chun, Thomas H</creatorcontrib><creatorcontrib>Cook, Lawrence J</creatorcontrib><creatorcontrib>Alpern, Elizabeth R</creatorcontrib><creatorcontrib>PECARN Registry Study Group and PECARN Child Abuse Special Interest Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaiyachati, Barbara H</au><au>Wood, Joanne N</au><au>Carter, Camille</au><au>Lindberg, Daniel M</au><au>Chun, Thomas H</au><au>Cook, Lawrence J</au><au>Alpern, Elizabeth R</au><aucorp>PECARN Registry Study Group and PECARN Child Abuse Special Interest Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>150</volume><issue>1</issue><spage>18</spage><pages>18-</pages><issn>0031-4005</issn><issn>1098-4275</issn><eissn>1098-4275</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>35707943</pmid><doi>10.1542/peds.2022-056284</doi></addata></record> |
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| subjects | Child Child abuse & neglect Child Abuse - diagnosis Child, Preschool Children Confidence intervals Coronaviruses COVID-19 COVID-19 - epidemiology Emergency medical care Emergency Service, Hospital Humans Pandemics Pediatrics Regression analysis Retrospective Studies United States - epidemiology |
| title | Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study |
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