BACKGROUND AND OBJECTIVE The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse. METHODS A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, 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 COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods. RESULTS Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not. CONCLUSIONS Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.

中文翻译：

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COVID-19 期间急诊科儿童虐待评估：一项多中心研究。

背景和目标 据报道，COVID-19 大流行对美国虐待儿童的影响喜忧参半。儿科急诊科儿童身体虐待的遭遇趋势可能会提供见解。因此，本研究试图确定与儿童身体虐待有关的急诊科遭遇率的变化。方法 一项儿科急救护理应用研究网络登记处的回顾性研究。与儿童身体虐待有关的遭遇通过 3 种方法确定：所有年龄段的儿童身体虐待诊断、有年龄限制的高风险伤害或有年龄限制的骨骼调查完成。主要结果是在 COVID-19 大流行之前（2018 年 1 月至 2020 年 3 月）和期间（2020 年 4 月至 2021 年 3 月）每天的遭遇率和临床严重程度。多变量泊松回归模型适合用边际估计方法估计比率。结果 在大流行期间，3 种识别方法中有 2 种的遭遇率显着下降。在完全调整的模型中，诊断代码队列中的遭遇率降低了 19%（调整后的比率：0.81 [99% 置信区间：0.75-0.88]，P <.001），学龄前和学龄前儿童的降幅最大年长的孩子。受伤队列中的遭遇率下降了 10%（调整后的比率：0.90 [置信区间：0.82-0.98]，P = .002）。对于所有 3 种方法，严重程度较低的遭遇率都显着降低，而严重程度较高的遭遇率却没有。结论 儿童身体虐待的遭遇率降低或保持不变。对于严重程度较低的遭遇以及学龄前和学龄儿童，减少幅度最大。这种模式需要进行批判性评估，以阐明大流行的变化是导致真正减少还是减少对儿童身体虐待的认识。