The Impact of the COVID-19 Pandemic on Pediatric Non-accidental Trauma

Background: Non-accidental trauma (NAT) is a global health issue and is responsible for 50,000 deaths worldwide and 1,800 deaths in the United States annually. Established risk factors for NAT include lower socioeconomic status and ethnic minority status. Memphis, TN has the nation’s second poorest metropolitan area, with greater than one-third of children living in poverty and a disproportionate number of those being ethnic minority children. The COVID-19 Pandemic, in addition to direct health effects, has brought with it increased financial and social hardship, possibly exacerbating the factors leading to violence against children. We sought to explore what impact the COVID-19 Pandemic had on the incidence of NAT within an already at-risk population.

Methods: Retrospective registry data was obtained for patients with suspected and confirmed NAT admitted through the Pediatric Emergency Department at our Level 1 Pediatric Trauma Center from 2011-2020. We compared the NAT rates before and during the COVID-19 Pandemic, designated as year 2020, using risk ratios and Chi-squared test. We conducted interrupted time series analysis to examine the impact of COVID-19 and time on the rate of NAT. A P-value ≤ 0.05 was considered statistically significant.

Results: The year 2020 showed an increase risk of NAT compared to prior years since 2011, both individually and as a whole. Interrupted time series analysis revealed a steady rise in NAT admissions over the last decade, but this rise was eight-fold above expected rates in the time of the COVID-19 Pandemic, RR 8.64 (95% CI: 3.3-13.9; p 0.006). There was decrease in emergency department encounters by 35.5% during the COVID-19 Pandemic compared to the average over the prior nine years. Patient demographics of NAT admissions prior to the COVID-19 pandemic and during the Pandemic did not significantly change. Injury Severity Score showed a decrease during the pandemic compared to the decade prior to the pandemic (p 0.002). Total hospital days were unaffected but total ICU days showed a decrease from 5.7 to 1.5 days (p <0.001).

Conclusion: Our study found a disproportionate increase in incidence of hospitalized NAT cases despite overall decreased volume of emergency department encounters during the COVID-19 Pandemic. Additionally, there was a decrease in injury severity and ICU length of stay, suggesting the increase in hospitalized NAT cases did not result in more critical injury, but rather increased frequency of mild-to-moderate severity of injury. We hypothesize the added social stress and financial impact of the COVID-19 Pandemic has resulted in heightened external stress on families, therefore increasing the risk of NAT in the pediatric population. Further evaluation on a national level, including non-hospitalized children, will need to be conducted. Our study supports the need for increased community awareness of NAT for at-risk children during times of social disruption and financial crisis.