Incidence of child abuse with subdural hemorrhage during the first year of the COVID-19 pandemic: a nationwide study in France

Abstract

The global COVID-19 pandemic prompted governments to impose unprecedented sanitary measures, such as social distancing, curfews, and lockdowns. In France and other countries, the first COVID-19 lockdown raised concerns about an increased risk of child abuse. Abusive head trauma (AHT) is one of the most serious forms of child abuse in children aged 0–24 months and constitutes the leading cause of death in children under 2 years of age. Subdural hemorrhage (SDH) is present in 89% of cases of AHT and constitutes one of the most specific, objective clinical presentations in the diagnosis of child abuse. In a French nationwide study, we sought to evaluate the potential impact of the first year of the COVID-19 pandemic on the incidence of hospital admissions for child abuse with SDH, relative to the two previous years. We conducted a nationwide, retrospective study of data in the French national hospital discharge summary database by applying the International Classification of Diseases (10th Revision) codes for SDH and for child abuse. After including children aged up to 24 months with a diagnosis of child abuse and/or SDH following hospital admission anywhere in France between January 1, 2018, and December 31, 2020, we compared the incidence of child abuse, the incidence of SDH + child abuse, and the demographic data for 2020 with the corresponding values for 2018 and 2019. There were no significant differences in the number of hospital admissions due to child abuse or SDH + child abuse between 2020 and the 2018/2019 control years. The incidence of SDH + child abuse was higher among boys than among girls. There were significantly fewer hospital admissions in May 2020 ( p = 0.01) and significantly more in December 2020 ( p = 0.03), relative to the same months in the two preceding years. There was a nonsignificant trend toward a lower incidence of hospital admission for child abuse in 2020, relative to 2019 (decrease: 6.4%) and 2018 (decrease: 7.6%). Conclusion: When considering children under the age of 24 months in France, the incidence of hospital admission for SDH in the context of child abuse was not significantly higher in 2020 than in the two previous years. What is Known: • The impact of COVID-19 lockdown on child abuse and more specifically on subdural hemorrhage remains unknown. What is New: • There was no increase in hospitalizations for child abuse and AHT. • We found that boys are more often victims of child abuse and subdural hemorrhage among children aged less than 12 months. Supplementary information The online version contains supplementary material available at 10.1007/s00431-022-04387-x.

Increased severity of abusive head trauma during the first year of the COVID-19 pandemic

“…In an analysis of the U.S. based PHIS database during the first six months of the pandemic, Maassel et al found no change in mortality for AHT patients compared to the three prior years ( Maassel et al, 2021 ). Similarly, Caron et al, who analyzed a nationwide French database, found no change in mortality among children 0–24 months old admitted for abusive subdural hemorrhage in the first 12 months of the COVID-19 pandemic compared to the two prior years ( Caron et al, 2022 ).…”

“…Intriguingly, an additional analysis of the same PHIS database by another group reported increased odds of AHT during the first three months of the pandemic ( De Boer et al, 2022 ). A review of the French national hospital registry reported a similar incidence of hospital admissions for subdural hemorrhages and mortality in the context of child abuse during the first year of the pandemic compared to the two prior years ( Caron et al, 2022 ). The authors of these four database studies recognize the limitations of their methodology, including reliance on International Classification of Diseases (ICD) codes, reliance on limited recorded data, and absence of case-specific information.…”

The monthly incidence of abusive head trauma, inflicted skeletal trauma, and unexplained skin lesion in children in six French university hospitals during the COVID-19 pandemic

“…Increased traumatic injuries were described during the first month after the closure of childcare facilities in an American pediatric trauma center ( Kovler et al, 2021 ), or AHT during the first month of the national lockdown in the United Kingdom ( Sidpra, Abomeli, Hameed, Baker, & Mankad, 2021 ). However, in France, no significant increase in children with subdural hematoma was observed during the first year of the pandemic compared with the two previous years ( Caron et al, 2022 ). But an important increase of the incidence and the severity of AHT was observed in the single regional pediatric neurosurgery center in Paris during the first two years of the pandemic ( Lãzãrescu et al, 2022 ).…”

COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review

“…Reports from other sources are mixed; violence and abuse hotlines note general increases in call volume ( De Boer et al, 2021 ; Loiseau et al, 2021 ; Petrowski et al, 2021 ; Rapoport et al, 2021 ), whereas emergency department records show more variation with reports of no changes ( Caron et al, 2022b ; Chaiyachati et al, 2022 ; Russell et al, 2020 ), decreases ( Bullinger et al, 2021b ; Chaiyachati et al, 2022 ; Stivaros et al, 2022 ;), as well as increases in both cases ( Amick et al, 2022 ; Bullinger et al, 2021c ; DeLaroche et al, 2021 ; Kovler et al, 2021 ; Loiseau et al, 2021 ; Sidpra et al, 2021 ), and severity of abuse ( De Boer et al, 2021 ). Several studies have also demonstrated a change in the distribution of types of CM, including dramatic increases in admissions related to neglect or lack of supervision ( Bullinger et al, 2021b ), and admissions related to pediatric abusive head trauma since the pandemic onset ( Sidpra et al, 2021 ).…”