Trends in Emergency Room Visits for Child Maltreatment in Georgia, 2016-2020 Open Access

Abstract

Objective: Data from the Georgia Hospital Association (GHA) Georgia Discharge Data System from 2016-2020 were analyzed to examine trends in child-maltreatment related Emergency Department (ED) visits. In addition, we compare prevalence of ED visits in 2 COVID-pandemic time periods of 2020 to their equivalent period of 2019 (April-June and October-December) to understand the impact that the pandemic had on child maltreatment-related care seeking.

Methods: ICD-10 ED discharge codes were adapted from ICD-9 codes in existing literature to identify cases of specified (visits with an explicit ICD-to code) and suggestive (diagnoses that suggest a likelihood of maltreatment or suspected maltreatment) child maltreatment in Georgia residents under 11 years of age. The prevalence of child maltreatment visits per 100,000 children in Georgia (based on CDC WONDER estimates) overall and by demographic factors were examined. Tests for trends over time were evaluated with Cochran-Armitage tests and tests comparing 2020 to 2019 were performed with chi-square tests, with statistical significance set at p<.01.

Results: Prevalence of specified maltreatment dropped from 47.5 per 100,000 in 2016 to 39.2 per 100,000 in 2020. Prevalence of suggestive maltreatment dropped from 205.0 per 100,000 in 2016 to 159.7 per 100,000 in 2019. Both were statistically significant declines. Prevalence of specified maltreatment dropped from 13.2 per 100,000 in April-June 2019 to 6.7 per 100,000 in in April-June of 2020. Prevalence of suggestive maltreatment dropped from 53.4 per 100,000 in April-June of 2019 to 37.2 per 100,000 in April-June of 2020. Both were statistically significant declines. Prevalence of specified child maltreatment rose insignificantly from 10.4 per 100,000 in October-December of 2019 to 11.7 per 100,000 in October-December of 2020. Prevalence of suggestive maltreatment declined significantly from 47.1 per 100,000 in October-December 2019 to 38.6 per 100,000 in October-December of 2020.

Conclusions: The GHA dataset is a useful tool for measuring child maltreatment ED visits in Georgia. The study indicates that the pandemic resulted in decreased visits for maltreatment and represents a barrier to accurately measuring the impacts of the pandemic on maltreatment. Future studies should examine later pandemic periods when healthcare avoidance was reduced.

Table of Contents

I. Introduction (1)

II. Methods (5)

III. Results (8)

IV. Discussion (19)

V. Conclusion (21)

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Discharge International Classification of Diseases Child Emergency Department COVID-19 Child abuse Child Maltreatment
Committee Chair / Thesis Advisor	Alison Cammack, Emory University Shakira Suglia, Emory University

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