Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut

Abstract

Background: Previous studies of national emergency department (ED) data demonstrate a decrease in visits coded for physical abuse during the pandemic period. However, no study to date has examined the incidence of multiple child maltreatment types (physical abuse, sexual abuse, and neglect), within a single state while considering state-specific closure policies. Furthermore, no similar study has utilized detailed chart review to identify cases, nor compared hospital data to Child Protective Services (CPS) reports.

Objective: To determine the incidence of child maltreatment-related ED visits before and during the COVID-19 pandemic, including characterizing the type of maltreatment, severity, and CPS reporting.

Participants and setting: Children younger than 18 years old at two tertiary-care, academic children's hospitals in X state.

Methods: Maltreatment-related ED visits were identified by ICD-10-CM codes and keywords in chief concerns and provider notes. We conducted a cross-sectional retrospective review of ED visits and child abuse consultations during the pre-COVID (1/1/2019-3/15/2020) and COVID (3/16/2020-8/31/2020) periods, as well as state-level CPS reports for suspected maltreatment.

Results: Maltreatment-related ED visits decreased from 15.7/week in the matched pre-COVID period (n = 380 total) to 12.3/week (n = 296 total) in the COVID period (P < .01). However, ED visits (P < .05) and CPS reports (P < .001) for child neglect increased during this period. Provider notes identified 62.4% of child maltreatment ED visits, while ICD-10 codes identified only-CM captured 46.8%.

Conclusion: ED visits for physical and sexual abuse declined, but neglect cases increased during the COVID-19 pandemic in X state.

Keywords: COVID-19 pandemic; Child neglect; Child physical abuse; Child sexual abuse; Emergency Department.