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Association of Economic Recession and Social Distancing With Pediatric Non-accidental Trauma During COVID-19.

  • Lewit, Ruth A1
  • Kotagal, Meera2
  • Duron, Vincent P3
  • Falcone, Richard A2
  • Fortenberry, Logan C4
  • Greene, H Michelle5
  • Leonard, Julie C5
  • Makoroff, Kathi2
  • Midura, Devin3
  • Moody, Suzanne6
  • Ramaiah, Veena7
  • Gosain, Ankush8
  • Slidell, Mark B7
  • 1 Le Bonheur Children's Hospital, Memphis, Tennessee.
  • 2 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • 3 Department of Surgery, Columbia University Irvine Medical Center, New York, New York; New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
  • 4 Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
  • 5 Nationwide Children's Hospital, Columbus, Ohio.
  • 6 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • 7 Comer Children's Hospital, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois.
  • 8 Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: [email protected]
Published Article
Journal of Surgical Research
Publication Date
Aug 01, 2022
DOI: 10.1016/j.jss.2022.02.038
PMID: 35339779


There has been concern that the incidence of non-accidental trauma (NAT) cases in children would rise during the COVID-19 pandemic due to the combination of social isolation and economic depression. Our goal was to evaluate NAT incidence and severity during the pandemic across multiple US cities. Multi-institutional, retrospective cohort study comparing NAT rates in children <18 y old during the COVID-19 pandemic (March-August 2020) with a recent historical data (January 2015-February 2020) and during a previous economic recession (January 2007-December 2011) at level 1 Pediatric Trauma Centers. Comparisons were made in local and national macroeconomic indicators. Overall rates of NAT during March-August 2020 did not increase compared to historical data (P = 0.8). Severity of injuries did not increase during the pandemic as measured by Glasgow Coma Scale (GCS) (P = 0.97) or mortality (P = 0.7), but Injury Severity Score (ISS) slightly decreased (P = 0.018). Racial differences between time periods were seen, with increased proportions of NAT occurring in African-Americans during the pandemic (P < 0.001). NAT rates over time had low correlation (r = 0.32) with historical averages, suggesting a difference from previous years. Older children (≥3 y) had increased NAT rates during the pandemic. Overall NAT rates had low inverse correlation with unemployment (r = -0.37) and moderate inverse correlation with the stock market (r = -0.6). Significant variation between sites was observed. Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates. Copyright © 2022 Elsevier Inc. All rights reserved.

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