Epidemiology of Injuries to 10–15-year-old Adolescents from Family Violence Evaluated in the Pediatric Emergency Department

Background: Studies of violence on early adolescent youth often focus on peer-assault injuries although the prevalence and circumstances of other violence related injuries are not well delineated. Our objective is to describe the epidemiology of violence-related injuries to 10–15-year-old adolescents from family violence, including child maltreatment and physical fighting, resulting in emergency department (ED) evaluation and treatment with comparison prior to and during the pandemic to understand its impact.

Methods: This is a retrospective cohort study in an urban academic pediatric ED and trauma center in the Mid-Atlantic region with an estimated annual census of 35,000 patients. The ED patient population is 60% Black/African American, 21% White/Caucasian, and 10% Hispanic/Latinx; 60% are enrolled in a public medical insurance plan. Using a query of electronic medical records and chart review, we identified visits for youth 10-15 years of age who presented for evaluation of an injury due to a violent event involving a family member between January 2019 and December 2020. The pre-pandemic period was defined as January 1, 2019-March 29, 2020 and the pandemic period was March 30, 2020 -December 31, 2020, based on the date of the Maryland stay-at-home order issue (March 30, 2020). Demographic and clinical data were abstracted, including circumstances of the event. Descriptive statistics were used to summarize data and t tests, chi square and Fisher's exact testing were used to evaluate comparisons.

Results: Of 819 youth 10-15 years of age evaluated for a violence-related injury during the overall study period, 448 (54.7%) reported that the event involved a family member. This proportion did not differ significantly between the pre-pandemic and pandemic periods (54.6% vs 54.9%, p=0.99). Most events involved parents/guardians (76.6%) and occurred at home (83.9%). The majority of patients were female (54.0%), Black/African-American (84.4%), and were enrolled in a public insurance plan (71.2%). Most youth were transported to the hospital by police (66.7%). Overall, alcohol, illegal drugs and weapons were involved in 10.0%, 6.5%, and 10.7% of events, respectively, and their involvement significantly increased during the pandemic period (from 10.0%, 6.5%, and 10.7% to 18.8% 14.9% and 23.8%; p≤.001); The most frequently reported weapon was a knife. Most patients received a social work consult (92.0%) and were discharged from the ED (98.7%).

Conclusion: More than half of violence-related injuries in our adolescent population occurred from family violence, including child maltreatment and physical fighting. The increased involvement of alcohol, illegal drugs and weapons during imposed stay at-home mandates requires investigation as a contributor to violence-related injuries during adolescence. Given that exposure to family violence increases an individual's risk for perpetrating violence in their own future relationships, the ED is an appropriate setting to identify at risk youth and initiate preventive interventions.