What is the Effect of COVID-19 Social Distancing on Oral and Maxillofacial Trauma Related to Domestic Violence?

Abstract

The COVID-19 pandemic has been an unprecedented crisis during which social distancing policies have been enacted and domestic violence (DV) has increased.1 Among victims of DV, trauma to the oral and maxillofacial region is 1 of the most common injury patterns.2 The purpose of this study was to understand the impact of social distancing policies on the incidence and severity of oral and maxillofacial trauma (OMFT) secondary to interpersonal violence (IPV) and DV.The authors designed a retrospective cohort study and enrolled a sample of subjects who presented to Harborview Medical Center (HMC), an urban Level I trauma center for the evaluation and management of OMFT between January 1 and December 31 in the years 2018 through 2020. The primary predictor variable was evaluation of OMFT during a period with (2020, investigational group) or without (2018, 2019, control group) social distancing policies in place. The primary outcome variables were the mechanism of injury, defined as IPV, DV, abbreviated injury scale (AIS), and the injury severity score (ISS). Univariate and bivariate analyses were performed with a statistical significance at P <.05.Overall, 8031 subjects presented with OMFT; 800 met inclusion criteria, 711 (89%) IPV versus 89 (11%) DV. IPV mean age (years): 39±15, 39±15, 38±15 in 2018, 2019, 2020 respectively (P = .66). DV mean age (years): 21±20, 17±22, 15±18 in 2018, 2019, 2020, respectively (P = .54). DV mean age was significantly younger than IPV (P < .001) per year. IPV subjects were predominantly male, 84%, 86%, 91% in 2018, 2019, 2020, respectively. For DV, males were more evenly matched to females; 50%, 59%, 53% in 2018, 2019, 2020, respectively. The majority of these males were pediatric and under 18. Caucasians were the majority ethnicity in both IPV and DV groups. While not significant, there was a decrease in percentage of Caucasians presenting for DV in 2020 (DV: 82%, 72%, 60% in 2018, 2019, 2020, respectively [P = .15]) (IPV: 57%, 60%, 56% in 2018, 2019, 2020, respectively [P = .72]).Subjects presenting with OMFT secondary to IPV was unchanged during social distancing (n = 220 in 2020) than without (2018: n = 249; 2019: n = 242) (P = .94). On average, those in 2020 with IPV had no difference in severity of OMFT; mean AIS =1.9±1.5, 1.9±1.5, 2.1±1.5 in 2018, 2019, 2020, respectively (P = .35) and no difference in overall injury severity: mean ISS = 10.7±8.3, 11.8±10.2, 12.4±10.7 in 2018, 2019, 2020, respectively (P = .14).Subjects presenting with OMFT secondary to DV were no different during social distancing (n = 32 in 2020) than without (2018: n = 29; 2019: n = 28; P = .49). A difference in AIS severity of OMFT was shown between groups: mean AIS =1.6±1.5, 2.6±1.5,1.9±1.7 in 2018, 2019, 2020, respectively (P = .05). Those who presented in 2020 with DV had an insignificant decrease in severity of OMFT compared to 2019 (P = .07) and no difference with 2018 (P = .58). There was no difference in overall injury severity: mean ISS = 9.7±6.9, 12.6±7.9, 11.8±10.9 in 2018, 2019, 2020, respectively (P = .42).The COVID-19 pandemic did not change the number of OMFT cases secondary to either IPV or DV. The severity of injury measured by AIS was significant between 2018 and 2019 controls, but insignificant when comparing either 2018 or 2019 to the investigational group (2020). The ISS was unchanged in all groups. Subjects of DV were consistently younger in age irrespective of COVID-19 social distancing measures. Further studies are recommended for this vulnerable group.