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Temporal Trends in Pediatric Injuries Due to Abuse, Personal Motorized Vehicles, and Firearms in Florida: Effects of the Pandemic and Social Determinants of Health
*Christopher W. Snyder1, Henry L Chang1, *Keith Thatch2, Lindsey B. Armstrong1, *Donald Plumley3, Robin T. Petroze4, *Shawn D. Larson4, Brian K. Yorkgitis5, John W. Fitzwater6, Oliver Lao7, Michele Markley8, Anne C. Fischer9, Felipe Pedroso10, Holly L. Neville7
1Johns Hopkins All Children's Hospital, Saint Petersburg, FL; 2Tampa General Children's Hospital, Tampa, FL; 3Orlando Health Arnold Palmer Hospital for Children, Orlando, FL; 4University of Florida Shands Children's Hospital, Gainesville, FL; 5University of Florida Jacksonville, Jacksonville, FL; 6St. Joseph's Children's Hospital, Tampa, FL; 7Joe DiMaggio Children's Hospital, Hollywood, FL; 8Broward Health Medical Center, Plantation, FL; 9Palm Beach Children's Hospital, West Palm Beach, FL; 10Nicklaus Children's Hospital, Miami, FL

Background: This study assessed temporal trends in pediatric trauma mechanisms in Florida: child abuse, personal motorized vehicles (golf carts/all-terrain vehicles, PMVs), and firearm injuries. We evaluated effects of social determinants of health and the SARS-Cov-2 (COVID) pandemic.
Methods: All Florida pediatric trauma centers (PTCs) were invited to submit trauma registry patients age <16 years from January 2016-June 2021. Children were classified by injury mechanism (abuse, PMV, firearm) and level of Social Vulnerability Index (SVI) risk by zip code. Each mechanism’s monthly incidence was trended over time. Interrupted time series and logistic regression assessed effects of COVID (pre-post March 2020) and SVI, within the context of long-term trends.
Results: A total of 23,539 children from 10 Florida PTCs were included (Figure). Abuse, PMV, and firearms accounted for 1.6%, 3.3%, and 1.6% of injuries, respectively. Monthly incidence of abuse increased overall, with the increasing trend persisting after COVID. PMV showed an increasing temporal trend which accelerated after COVID. Firearms showed an overall decreasing temporal trend, but increased after COVID. Among 19,688 patients with valid zip codes, low SVI was associated with lower risk of child abuse (odds ratio 0.67, 95% confidence interval 0.52-0.87) and firearm injury (OR 0.72, 95% CI 0.56-0.92).
Conclusions: This large multicenter analysis suggests that child abuse and PMV injuries are increasing in Florida, with COVID either accelerating trends or leaving them unchanged. A pre-COVID trend of decreasing pediatric firearm injuries may have been reversed, with firearm injuries now rising in the COVID era. Social determinants of health may help mitigate child abuse and firearm injury. These data can guide further study and injury prevention efforts in Florida.


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