COVID-19 Resilience for Survival: Occurrence of Domestic Violence During Lockdown at a Rural Acs (American College of Surgeons) Verified Level One Trauma Center

Saptarshi Biswas and Heather Rhodes
Grans Strand Medical Center,Myrtle Beach,South Carolina

Abstract

Background. As the novel coronavirus outbreak has intensified globally, stay at home mandates requiring identified individuals as nonessential were advised to remain home to prevent community transmission of the disease. Further mandates escalated isolated environments such as school closures, social distancing, travel restrictions, closure of public gathering spaces, and business closures. As citizens were forced to stay home during the pandemic, the crisis created intensifying stressors and isolation, which fostered an environment for increased domestic violence. Methods. A retrospective review of all trauma patients that presented to an ACS verified rural level one trauma center with associated diagnostic coding for assault was conducted during the COVID-19 lockdown. The identified proportional assaults presenting to the emergency department (ED) after school closures (March 16, 2020) to April 30, 2020, as compared to the previous year (March 16, 2019, to April 30, 2019). The data collected included patient characteristics, grouping by mechanism, grouping by a specific mechanism, and domestic violence perpetrators. Results. During the time period of March 16, 2019, to April 30, 2019, a total of 7008 trauma patients presented to the ED, which included 78 assault patients. Through March 16, 2020, to April 30, 2020, a total of 2900 trauma patients presented to the ED, which included 50 assault patients. Assault patients (N=50) during the COVID-19 lockdown was compared to assault patients the previous year (N=78) using a Chi-square two way test for homogeneity. This method used identified relationships between proportions of ED visits from the two populations of total trauma volume for the single assault categorical variable. A statistically significant (P=0.01) increase in assaults was found during the COVID-19 lockdown, particularly during the period after school closures. Demographically this increase was associated with white (72%) males (62%). The comparison years of 2019 to 2020 showed increased mechanisms of assault was largely penetrating, which included cut/pierce (2.6% vs. 18%) and knife (0% vs. 12%) injuries. Blunt injuries from 2019 to 2020 were reduced (84.6% vs. 56%). Domestic violence perpetrators by husbands during the COVID-19 lockdown showed a dramatic reduction during the study periods (33.3% vs. 0.0%). Increases in domestic violence during the comparative years were largely associated with male partners (0% vs. 25%) and unspecified non-family members (0% vs. 25%). Conclusions: Although overall trauma acuity was reduced during the COVID-19 stay at home mandates, a significant increase in domestic violence assaults was observed. Largely the assaults were perpetrated against white men by partners and unspecified non-family members, which were predominantly penetrating injuries.


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