The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic

Cowley, Laura; Adesman, Andrew

doi:10.1542/peds.2021-050612

Cited by 4 publications

(9 citation statements)

References 18 publications

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“…[1,2] Several studies have demonstrated that the risk of violence in families increased with the incidence rate of in icted injury owing to economic stress, thereby increasing the risk of abusive head trauma by 14% for each day of social isolation after the beginning of the pandemic. [3][4][5][6][7][8][9] Indeed, this tendency has been reported by previous observations of increased interpersonal violence during natural disasters and unemployment that accompanied economic recession. [10][11][12] Children were especially affected with regard to their interpersonal relationships: their school activities were restricted, and their risk for suffering violence in the home increased.…”

Section: Introductionmentioning

confidence: 64%

“…[10][11][12] Children were especially affected with regard to their interpersonal relationships: their school activities were restricted, and their risk for suffering violence in the home increased. [9] The World Health Organization declared the COVID-19 pandemic on March 11, 2020. [6] In Brazil, the rst case of COVID-19 was reported on February 26, 2020, in São Paulo, and stay-at-home measures were implemented in the 27 states of Brazil.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Injury in Brazil

Furtado,

Filho,

Pereira

et al. 2023

Preprint

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Purpose Globally, governments have implemented measures in response to the COVID-19 pandemic. These measures raised social psychological concerns, causing increased stress among parents and restricted children’s freedom of movement. These factors might led to increased exposure of children to violence, which might result in abusive head trauma. Whether pandemic-related socioeconomic and environmental changes significantly affected the incidence and severity of pediatric traumatic brain injury (TBI) remains unexplored. We aimed to investigate the consequences of the pandemic on the mechanisms and severity of pediatric TBI and related mortality in Brazil. Materials and methods We investigated the patients with TBI aged <18 years who visited a tertiary trauma center in Brazil in 2019 and 2020.The variables included TBI classification, mechanism of trauma, clinical manifestations, need for neurosurgical intervention, and rates of morbidity and mortality. Furthermore, we used a nationwide databank to collect information on mortality from external causes of trauma and violence in the pediatric population both before and during the pandemic. Results Of the patients with traumatic brain injury, 1371 visited the trauma center in 2019 and 1052 in 2020. No difference was noted in the incidence rate of abusive head trauma between these periods (P= 0.142) or in mortality from violence in Brazil. Falls from bicycles significantly increased during the pandemic (P < 0.001). Conclusion In Brazil, rates of abusive head trauma did not increase during the COVID-19 pandemic, but recreational mechanisms of pediatric TBI did increase. A program to educate the population about recreational safety should be implemented.

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Section: Introductionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Injury in Brazil

Furtado,

Filho,

Pereira

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Clinicians and researchers have remained appropriately concerned that the decline in physical abuse seen with the pandemic may represent missed cases due to decreased interactions of children and families with mandated reporters in the community . Of particular concern were mild cases that might have been able to go undetected during periods of decreased health care use and childcare availability during stay-at-home orders .…”

Section: Discussionmentioning

confidence: 99%

“…To evaluate the association of COVID-19 with trends for AHT hospitalizations, an interrupted time-series analysis was performed using hospitalizations aggregated by month with a total of 76 data points. 24 All cases reported from contributing hospitals in a given month were aggregated to calculate total monthly hospitalizations over a period from January 2016 to April 2022, for a total of 76 months of data; 45 hospitals contributed at least 1 case to the analyses, but not all hospitals reported cases each month. Additionally, the interrupted time series was repeated for the subgroup of patients younger than…”

Section: Discussionmentioning

confidence: 99%

“…a total of 76 data points. 24 All cases reported from contributing hospitals in a given month were aggregated to calculate total monthly hospitalizations over a period from January 2016 to April 2022, for a total of 76 months of data; 45 hospitals contributed at least 1 case to the analyses, but not all hospitals reported cases each month. Additionally, the interrupted time series was repeated for the subgroup of patients younger than 1 year as these patients are at higher risk of physical abuse occurrence.…”

Section: Meaningmentioning

confidence: 99%

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Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

Maassel,

Graetz,

Schneider

et al. 2023

JAMA Pediatr

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ImportanceSeveral studies have demonstrated a decrease in the occurrence of child abuse in the US since the start of the COVID-19 pandemic. This finding has generated concern for missed cases due to the initial lockdowns and lack of childcare resources. Determining the association of the pandemic on hospitalizations for severe forms of abuse is essential to focus preventive efforts.ObjectiveTo examine trends in abusive head trauma (AHT) before and during the COVID-19 pandemic.Design, Setting, and ParticipantsRetrospective, multicenter, repeated cross-sectional study, conducted January 1, 2016, through April 30, 2022, with data from tertiary care children’s hospitals and contributors to the Pediatric Health Information System. Data were obtained for 2380 hospitalizations of children younger than 5 years with International Classification of Diseases, Tenth Revision, Clinical Modification codes for both abuse and head trauma.Main Outcomes and MeasuresMonthly hospitalizations were analyzed using interrupted time-series analysis. Hospitalization severity (eg, intensive care unit stay) and clinical characteristics (subdural hemorrhages and retinal hemorrhages) were compared before and after the start of the pandemic.ResultsWe identified 2380 hospitalizations due to AHT (median age, 140 [IQR, 75.0-325.5] days) from 45 hospitals. The mean (SD) monthly incidence of AHT was 34.3 (5.8) before the COVID-19 pandemic compared with 25.6 (4.2) during COVID-19 (a 25.4% decrease). When the pre–COVID-19 and during COVID-19 periods were compared, there were no significant differences in severity or clinical characteristics. On interrupted time-series analysis, there was a significant decrease in the number of monthly hospitalizations (−8.1; 95% CI, −12.41 to −3.72; P &lt; .001) in the first month of the pandemic. In the subgroup of children younger than 1 year, there was a significant decrease in monthly hospitalizations at the onset of the pandemic (−8.2; 95% CI, −12.02 to −4.43; P &lt; .001) followed by a significant temporal increase across the COVID-19 period (P = .01).Conclusions and RelevanceThe findings of this cross-sectional study suggest there was a significant decrease in monthly hospitalizations for AHT following the start of the pandemic in March 2020. Although there was no corresponding increase in hospitalization severity, the decrease during the pandemic may have been transient, as monthly hospitalizations for children younger than 1 year increased significantly over time during COVID-19, after the initial decrease.

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

et al. 2022

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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.

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The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic

Cited by 4 publications

References 18 publications

Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Injury in Brazil

Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Injury in Brazil

Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

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

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