213 - Child Abuse and Neglect Presentation to NYC Public Hospital Emergency Departments During the COVID-19 Pandemic

Poster Number: 213
Publication Number: 213.401

Yasmin Soliman, Albert Einstein College of Medicine/NYC Health+Hospitals/Jacobi, Brooklyn, NY, United States; Megha Dasani, Albert Einstein College of Medicine/NYC Health+Hospitals/Jacobi, New York, NY, United States; Tian Liang, New York University Grossman School of Medicine, New York, NY, United States; James Meltzer, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Noe D. Romo, Albert Einstein College of Medicine/ NYC Health+Hospitals/Jacobi, Bronx, NY, United States; Haamid Chamdawala, Albert Einstein College of Medicine, Brooklyn, NY, United States

Background: The first year of the COVID-19 Pandemic resulted in a large decline in pediatric emergency department (PED) visits nationwide. This may have limited the exposure of children to traditional safeguards for the detection of child abuse and neglect (CAN). We sought to report CAN PED visits to the New York City Health and Hospitals (NYC H+H) system, the largest public health system in the United States, serving as a safety net to millions of New Yorkers.

Objective: The purpose of this study was to describe trends in CAN PED visits during the first year of the COVID-19 pandemic in 2020 and compare them to a similar time period in 2019.

Design/Methods: We conducted a retrospective study across 11 PEDs in the NYC H+H system. Data was abstracted for patients < 18 years old seen in the PED with a CAN visit from March 1 to December 31 in 2019 and 2020. The number of CAN visits per week, demographics, and injury severity (ESI) were abstracted from the medical record. ESI 1 & 2 were considered high severity visits. Subgroup analyses were performed by time period, March 1 - June 7 [early pandemic] versus June 8 - December 31 [late pandemic], corresponding to NYC full lockdown and reopening. Group differences were compared using Mann-Whitney and chi-squared tests.

Results: Of the 219,688 total PED visits, 1,654 were CAN visits; 957 (57%) in 2019 and 697 (42%) in 2020. The median weekly CAN visits were significantly lower in 2020 (17 [IQR 13, 21]) compared to 2019 (21 [IQR 18, 25]; p=0.002). The change in the median number of weekly CAN visits was most pronounced in the early pandemic period in 2020 (13 [IQR 7, 15]) compared to the same time period in 2019 (24 [IQR 21, 27]; p < 0.001). The CAN visit volume during the late pandemic period also decreased compared to the prior year but this difference was not statistically significant. There was also a significant increase in the percentage of CAN visits with a high ESI (145 [21%] vs. 135 [14.2%], p < 0.001) and visits resulting in hospitalization (48 [6.9%] vs. 38 [4.0%], p=0.008) in 2020 compared to 2019.Conclusion(s): There was a significant decrease in weekly CAN PED visits during the COVID-19 pandemic compared to the prior year, with the largest decrease in the early pandemic period. Despite this decrease in total visits, there was a significant increase in visits with high severity and visits resulting in hospital admission. These differences may reflect a true decrease in CAN incidence or a decrease in reporting, as school closures and lockdown orders would have limited interactions of CAN patients with mandated reporters and others outside the immediate family.