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Such changes in health care use can be attributed in part to anxieties around contracting COVID-19. 12 Although the number of presentations decreased, the percentage requiring hospital admission increased in children aged 0 to 4 years, suggesting that less severe cases are not being brought for care. For example, national US data reveal that patterns in child abuse–related emergency department presentations changed during the pandemic. 2, 3, 10, 11 Existing challenges in the identification of AHT have been exacerbated by COVID-19-associated physical-distancing measures. Evidence suggests that even when medical care is sought, many AHT cases go unrecognized by medical professionals, even without the additional challenges posed by the pandemic. However, the brief acknowledgment that “mild cases of AHT may be able to forgo care” 5 necessitates discussion. Maassel et al 5 hypothesized that because of the severity of AHT, it is difficult for caregivers to forgo seeking medical care for the child, implying that the decrease in hospitalizations represents a true decrease in AHT incidence. These studies highlight the value of national administrative data in facilitating rapid, population-wide child abuse surveillance studies that will ultimately help to inform public health policy and practice. A major strength of the studies conducted by Maassel et al 5 and Kaiser et al 6 is the inclusion of 6 months of data from multiple children’s hospitals across the United States. 7 In contrast, Sanford et al 9 reported a decrease in the number of emergency department visits for blunt trauma at 1 US tertiary pediatric hospital during the first 2 months of the pandemic and no corresponding increase in the proportion of suspected abuse cases. Although the authors of one UK study reported an alarming 1493% rise in the incidence of AHT during the pandemic compared with equivalent time periods in the 3 previous years, the data represented only 1 institution over the first month of the national lockdown.
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6Īs Maassel et al 5 note, their findings differ from earlier single-center studies documenting an increase in the number 7 or proportion 8 of children presenting with abuse-related injuries during the COVID-19 pandemic.
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5 The study findings echo those of a recent similar US study that used the Pediatric Health Information System database to investigate emergency visits and hospitalizations for all types of physical child abuse during the COVID-19 pandemic. In addition, there were no statistically significant differences in the proportion of children who were admitted to an ICU, required a ventilator, presented with subdural or retinal hemorrhage, or died of their injuries. There was a statistically significant decrease in hospital admissions for AHT during the COVID-19 pandemic compared with each previous year. Using data from the Pediatric Health Information System database, the authors compared mean hospital admission rates for AHT and key demographic and admission characteristics at 49 children’s hospitals during March to September 2020 with those across the same months of the preceding 3 years. 4 In this issue of Pediatrics, Maassel et al 5 report findings from a national study conducted in the United States that examined changes in the frequency of AHT hospitalizations during the COVID-19 pandemic. As a result, concerns have been raised that children may be at increased risk for physical abuse and that some cases may go undiagnosed. The coronavirus disease 2019 (COVID-19) pandemic has had a profound adverse impact on families and households.