170 - Changes in Hospital Encounters for Child Physical Abuse Throughout the COVID-19 Pandemic

Poster Number: 170
Publication Number: 170.1533

Background: Violence towards children was expected to increase with the COVID-19 pandemic. Instead, early decreases with a return to normal volume by August of 2020 have been reported. Lag effects of pandemic-related stressors, however, remain a concern as COVID stimulus and relief policies lapsed.

Objective: To compare the volume of hospital encounters for child physical abuse during the pandemic to pre-pandemic volumes.

Design/Methods: This was a retrospective cohort study of hospital encounters (emergency department visits and hospitalizations) at 42 U.S. children’s hospitals. We measured counts of encounters for abuse among children < 5 years and abuse-related injuries among infants < 12 months (injuries concerning for abuse: bruising, extremity fracture, or traumatic brain injury). Pandemic periods were defined a priori based upon documented patterns of healthcare use, public health pandemic responses, and phasing out of COVID stimulus and relief policies: pre- (Jan 2018-Feb 2020), early- (Mar 2020-Aug 2020); mid- (Sept 2020-Dec 2021); and late- (Jan 2023-June 2023). Wilcoxon Rank Sum tests compared median monthly volume of encounters (interquartile range [IQR]) for each pandemic period to pre-pandemic. Interrupted time series compared late- to pre-pandemic volumes. In response to these results, we calculated the % change in monthly encounters for abuse among Hispanic children compared to pre-pandemic volume.

Results: Compared to pre-pandemic volume (294 [IQR 284, 326]), the volume of encounters for abuse appeared lower during the early-pandemic (280 [IQR 240, 298]), higher during the mid-pandemic (321 [IQR 307, 325]), and unchanged during the late-pandemic (300 [IQR 286, 316]), but none were statistically significant (p= 0.06, 0.07, and 0.73, respectively; Figure 1). Interrupted time series found a modest drop in cases between late- and pre-pandemic periods, but no significant trends for either period (Figure 2). The percent of abuse cases among Hispanic children increased significantly during the pandemic (pre 15.0%, early 17.6%, mid 18.3%, late 20.3%; p < 0.001). Figure 3 shows the increasing % change in monthly volume of abuse encounters for Hispanic children from pre-pandemic volumes. Compared to pre-pandemic (875 [IQR 822, 951]), abuse-related injuries were significantly decreased early-pandemic (758 [IQR 681, 828]; p 0.01), but unchanged mid- and late-pandemic.

Conclusion(s): Violence towards young children appears relatively unchanged overall from prior to the COVID-19 pandemic. However, abuse among Hispanic children increased throughout the pandemic.