# An Analysis of Child Abuse Detected by Skeletal Surveys Before and During the COVID‐19 Pandemic

## TL;DR

This study examines how the COVID-19 pandemic affected child physical abuse patterns, finding no change in overall abuse rates but a decrease in certain injuries.

## Contribution

The study reveals a significant decrease in intracranial and retinal hemorrhages in child abuse cases during the pandemic.

## Key findings

- The overall incidence of child physical abuse remained stable before and during the pandemic.
- There was a significant decrease in intracranial and retinal hemorrhages during the pandemic.

## Abstract

The COVID‐19 pandemic and the stay‐at‐home order may have impacted the risk of child physical abuse (CPA). Analyzing injury types in suspected CPA cases before and during the pandemic can provide valuable insights. The objective of this study is to compare the incidences and types of injuries detected by skeletal surveys in suspected CPA cases at a large academic children's hospital before and during the COVID‐19 pandemic. The study compared the incidences and proportion of specific injury sites, types of traumas, and demographic characteristics before and during the pandemic using Pearson's chi‐squared and Fisher's exact tests. A total of 479 patients who underwent skeletal surveys were included, with 306 patients sampled before the pandemic (63.8%) and 173 patients sampled during the pandemic (36.1%). There were no significant differences in age, gender, or ethnicity between the two groups. Highly suspicious CPA incidences were similar before (0.87/month) and during (0.81/month) the pandemic, reflecting 10.5% and 11.6% of all patients who underwent skeletal surveys, respectively. There were no significant demographic differences between the groups. However, the proportion of patients with intracranial or retinal hemorrhage significantly decreased (p < 0.05) during the pandemic, with no significant differences in types of skeletal fractures. In conclusion, the overall incidence of CPA remained similar before and during the pandemic. The significant decrease in intracranial and retinal hemorrhages suggests a potential change in injury patterns or reporting. Further research is needed to understand the factors contributing to these findings.

This study is a retrospective clinical trial and therefore not subject to clinical trial registration requirements.

This study analyzes the impact of the COVID‐19 pandemic on child physical abuse patterns, revealing a stable overall incidence but a significant decrease in intracranial and retinal hemorrhages detected by skeletal surveys.