222 - Inpatient and Outpatient Child Maltreatment Identification Before and During the COVID Pandemic

Poster Number: 222
Publication Number: 222.401

Elizabeth Hisle-Gorman, Uniformed Services University, Bethesda, MD, United States; Madeline Dorr, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, McLean, VA, United States; Apryl Susi, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Maxwell Ebert, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Ian S. Sorensen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Jayasree Krishnamurthy, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Cade M. Nylund, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: COVID-19 pandemic era stressors have affected family functioning. Smaller hospital and parental studies indicate increased child maltreatment risk related to COVID-19, however do not generally differentiate between in- and outpatient care or maltreatment type.

Objective: To examine changes in diagnosis of child maltreatment during the COVID-19 pandemic.

Design/Methods: This retrospective cross-sectional study used the Military Health System database to examine child maltreatment in- and outpatient care during the first year of the COVID-19 pandemic. Time periods were categorized as COVID-19 months 0-6 (March-Aug 2020), COVID-19 months 7-12 (Sept 2020-Feb 2021), and compared to pre-pandemic (Sept 2019-Feb 2020). Maltreatment was identified by ICD-10 codes for physical abuse, neglect, sexual abuse, emotional abuse, and unspecified maltreatment. Outpatient outcomes were examined individually and grouped, inpatient diagnoses were only grouped. Outpatient maltreatment proxy diagnoses (ICD codes which indicate maltreatment by age) were a separate “proxy” category. Poisson regression analysis compared COVID-19 maltreatment rates to pre-pandemic rates.

Results: An average of 1,841,381 children aged 0-17 were included each study month. As compared to the pre-pandemic period, care for all outpatient diagnoses decreased in COVID-19 months 0-6: physical abuse (24%), sexual abuse (9%), emotional abuse (32%), unspecified maltreatment (19%), maltreatment proxy diagnoses (19%), and grouped outpatient diagnoses (18%). In COVID-19 months 7-12 outpatient care remained decreased as compared to the pre-pandemic period for physical abuse (11%), emotional abuse (34%), and grouped outpatient diagnoses (9%); care for the remaining diagnoses returned to pre-pandemic levels. Outpatient care for child neglect and inpatient care for any maltreatment did not significantly change in COVID-19 months 0-6, or COVID-19 months 7-12 as compared to pre-pandemic rates (Figure 1, Table 1).Conclusion(s): Findings of no increased child maltreatment in this large military sample may indicate that parental military employment, and related housing, school and childcare confer some protection from pandemic stressors. Decreased outpatient diagnosis of child maltreatment in COVID-19 months 0-6 and returns of most categories of diagnosis to pre-pandemic rates in COVID-19 months 7-12 suggest barriers to healthcare access likely resulted in missed identification of child maltreatment. Stable rates of inpatient diagnoses suggest that severe maltreatment continued to be identified.
Figure 1: In- and Outpatient Child Maltreatment Rates Before and During COVID-19 by Type of Maltreatment