Publication date: May 19, 2025

Trauma is the leading cause of morbidity and mortality for children in the United States, of which pediatric nonaccidental trauma (pNAT) accounts for more than 550,000 cases annually. To our knowledge, there have been no published mapping studies to specifically assess pNAT incidence or how pNAT geographic distributions have been influenced by the COVID-19 pandemic. We performed a geographic information system analysis to evaluate longitudinal trends of pNAT over 10 years by creating a hot spot mapping model to identify locations with high pNAT incidence and compare with risk factors like social deprivation indices (SDI). We performed a retrospective observational cohort study from 2013 to 2023 using subjects aged 0 to 18 years treated at two local pediatric trauma centers. Data sets were collated into three periods: pre-COVID (2013-2019), peak COVID (2020), and endemic COVID (2021-2023). Basic descriptive statistics were performed to analyze average cases of pNAT per year during each time period. Then ArcGIS Pro software (Esri Inc. , Redlands, CA) was used to map pNAT locations to determine trauma density (pNAT trauma frequency/population at given zip code) and perform ordinary least squares regression to examine associations of trauma density with zip code-associated SDI scores. There was a statistically significant increase in mean annual pNAT incidence from before COVID (311) to during peak COVID (342) and after peak COVID (374) (p < 0. 05). Furthermore, the mean age of pNAT dropped from 11. 6 to 10. 5 years during and after peak COVID, disproportionately affecting children younger than 10 years (p < 0. 05). Ordinary least squares regression showed pNAT density was correlated with higher SDI throughout all periods (p < 0. 05). This statistically significant relationship between SDI and pNAT occurrence, alongside persistently higher pNAT incidence since peak COVID, suggests a worsening public health need. Our data can help inform enhanced screening tools and help mobilize resources. Therapeutic/Care Management; Level IV.

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