Background

Abusive head trauma (AHT) is the leading cause of death from physical abuse in children. Reports regarding the impact of the COVID-19 pandemic on rates and severity of AHT are limited and with conflicting results.

Objective

To determine the number and clinical characteristics of AHT cases presenting to a pediatric tertiary care center during the first year of the COVID-19 pandemic compared to the two prior years.

Participants and setting

We performed a retrospective cohort study of patients <5 years old diagnosed with AHT at a single pediatric tertiary care center over a three-year period.

Methods

Data were obtained for the pandemic year and two years before, including demographics, length of stay, physical and retinal examination findings, radiologic studies, electroencephalogram results, and mortality.

Results

There were 27 cases of AHT during the first year of the pandemic and 55 during the two pre-pandemic years. Length of stay was similar for the two cohorts. The mortality rate was higher during the pandemic (29.6 % vs. 3.6 %; p < .01), as were the proportion of patients with retinal hemorrhages (84.6 % vs. 41.5 %; p < .01) and abnormal cervical spine imaging (52.6 % vs. 21.2 %; p = .02). There were no differences in age, sex, race, abnormalities on dermatological exam, skeletal surveys, and electroencephalograms.

Conclusions

We did not observe an increase in the number of patients with AHT during the pandemic but did see an increase in mortality, patients with retinal hemorrhages, and patients with abnormalities on cervical spine imaging. These data suggest a higher severity of AHT presenting to a pediatric tertiary care center during the pandemic.

中文翻译：

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在 COVID-19 大流行的第一年，虐待性头部外伤的严重程度增加

背景

虐待性头部外伤 (AHT) 是儿童身体虐待导致死亡的主要原因。关于 COVID-19 大流行对 AHT 发生率和严重程度的影响的报告有限，而且结果相互矛盾。

客观的

与前两年相比，确定在 COVID-19 大流行的第一年出现在儿科三级医疗中心的 AHT 病例的数量和临床特征。

参与者和设置

我们对在一家儿科三级医疗中心诊断为 AHT 的 5 岁以下患者进行了为期三年的回顾性队列研究。

方法

获得了大流行一年和两年前的数据，包括人口统计数据、住院时间、身体和视网膜检查结果、放射学研究、脑电图结果和死亡率。

结果

在大流行的第一年有 27 例 AHT 病例，在大流行前的两年中有 55 例。两组的住院时间相似。大流行期间死亡率较高（29.6% 对 3.6%；p < .01），视网膜出血（84.6 % 对 41.5 %； p  < .01）和颈椎影像学异常 患者的比例也较高（ 52.6% 与 21.2%；p  = .02）。在年龄、性别、种族、皮肤病学检查、骨骼检查和脑电图异常方面没有差异。

结论

我们没有观察到大流行期间 AHT 患者数量的增加，但确实看到死亡率、视网膜出血患者和颈椎影像学异常患者的增加。这些数据表明，在大流行期间，儿科三级医疗中心出现的 AHT 严重程度更高。