436 Non-accidental injury and abusive head trauma in children – is the COVID-19 pandemic impacting teesside differently?

Davidson, Matthew C.; Saran, Shashwat; Mansoor, Qasim; Salisbury, Thomas

doi:10.1136/bmjpo-2021-rcpch.247

Cited by 1 publication

(4 citation statements)

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“…Also, Sidpra et al 16 reported an increase of 1500% in the incidence of AHT in children. Other studies reported no change in the incidence of CAN [23][24][25][26] or a decrease up to 50% in emergency department visits related to CAN 21 and 50% decrease of children with AHT 20 (eTable 1 in the Supplement). This discrepancy can be secondary to the specific situation of the Paris metropolitan area (a region heavily affected by the COVID-19 pandemic, with compulsory mitigation measures, and with the majority of the population living in small collective housing).…”

Section: Jama Network Open | Pediatricsmentioning

confidence: 99%

“…The discrepancy can also be secondary to the definitions and design of these previous studies. Indeed, these studies 20,[22][23][24]26 compared the incidence of CAN or AHT during the second and/or third quarter of 2020 with the prepandemic period but did not explore the incidence of AHT in 2021, making it impossible to assess the medium-term consequences of the pandemic and the mitigation measures taken. The increase in mortality could be explained by an increased delay between the trauma and the first medical examination, 50 leading to untreated seizures and additional brain damage.…”

Section: Jama Network Open | Pediatricsmentioning

confidence: 99%

“…9,12 Concerns were raised early regarding a potentially marked increase in CAN (notably AHT) in association with the COVID-19 pandemic and related containment and mitigation measures. [13][14][15] Studies evaluating the association of the COVID-19 pandemic and containment and mitigation measures with the incidence and severity of CAN and AHT led to conflicting conclusions, varying from a significant increase, [16][17][18][19] a significant decrease, [20][21][22] or no change [23][24][25][26] (eTable 1 in the Supplement). These contradictory findings may be secondary to regional variability in the prepandemic epidemiology of CAN and social programs and the COVID-19 pandemic intensity and containment and mitigation measures taken.…”

Section: Introductionmentioning

confidence: 99%

“…Studies evaluating the association of the COVID-19 pandemic and containment and mitigation measures with the incidence and severity of CAN and AHT led to conflicting conclusions, varying from a significant increase, a significant decrease, or no change (eTable 1 in the Supplement). These contradictory findings may be secondary to regional variability in the prepandemic epidemiology of CAN and social programs and the COVID-19 pandemic intensity and containment and mitigation measures taken.…”

Section: Introductionmentioning

confidence: 99%

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Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area

et al. 2022

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IMPORTANCEThe COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse. OBJECTIVE To investigate the trend of abusive head trauma (AHT) incidence and severity in infants during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTSIn a time-series analysis of a longitudinal, populationbased, cohort study, all consecutive cases of AHT in infants younger than 12 months old referred between January 2017 and December 2021 to Necker Hospital for Sick Children, the single regional pediatric neurosurgery center for the Paris metropolitan area, were included. AHT was defined as 1 or more subdural hemorrhage and a positive multidisciplinary evaluation after a social, clinical, biological, and radiological workup. Data were analyzed from January to March 2022. MAIN OUTCOMES AND MEASURESThe primary outcome was the monthly incidence of AHT, which was analyzed using Poisson regression modeling. Secondary outcomes included mortality and severe morbidity and were studied with logistic and linear regressions. The monthly incidence of neurosurgical interventions for hydrocephalus was used as a control series. RESULTS Among the 99 included infants with AHT (median [IQR] age, 4 [3-6] months; 64 boys[65%]), 86 of 99 (87%) had bridging vein thrombosis, 74 of 99 (75%) had retinal hemorrhages, 23 of 72 (32%) had fractures, 26 of 99 (26%) had status epilepticus, 20 of 99 (20%) had skin injuries, 53 of 99 (54%) underwent neurosurgical interventions, and 13 of 99 (13%) died. Compared with the prepandemic period (2017-2019), AHT incidence was stable in 2020 (adjusted incidence rate ratio, 1.02; 95% CI, 0.59-1.77) and then significantly increased in 2021 (adjusted incidence rate ratio, 1.92; 95% CI, 1.23-2.99). The severity of AHT worsened in 2021 in terms of mortality (odds ratio 9.39; 95% CI, 1.88-47.00). Other secondary outcomes and the control series were not significantly modified. CONCLUSIONS AND RELEVANCEIn this cohort study, a marked increase in AHT incidence and severity occurred during the COVID-19 pandemic in the Paris metropolitan area. These results suggest the need for clinical awareness and preventive actions.

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