Child abuse evaluations in emergency departments drop during pandemic, but reason unclear

Pediatric Emergency Department (ED) encounters related to physical abuse decreased by 19 percent during the COVID-19 pandemic, according to a multicenter study published in the journal Pediatrics. While encounter rates with lower clinical severity dropped during the pandemic, encounter rates with higher clinical severity remained unchanged. This pattern raises concern for unrecognized harm, as opposed to true reductions in child abuse.

"Although our results show a decrease in ED encounters for physical abuse in children, especially for cases with lower clinical severity, it is unclear if this indicates an actual decrease in child abuse during the pandemic," said senior author Elizabeth Alpern, MD, MSCE, Division Head of Emergency Medicine at Ann & Robert H. Lurie Children's Hospital of Chicago and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "With so many kids attending school remotely, abuse might not have been easily detected by school personnel. Also, children with less severe injuries might not have been brought for in-person medical care during the pandemic. We need further investigation to understand the true reasons behind our results."

Dr. Alpern and colleagues found that the greatest reduction in ED encounters for physical abuse concerns were in preschool children, followed by school-aged children.

The study used data from the Pediatric Emergency Care Applied Research Network. Encounters related to child physical abuse were identified by three methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury diagnosis codes, 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 coronavirus disease 2019 pandemic (April 2020–March 2021).