1. In a study of 49 hospitals, admissions for abusive head trauma (AHT) during the first 7 months of the COVID-19 pandemic were significantly lower compared to the previous 3 years.
2. Given the life-threatening nature of AHT and the necessity of presenting to care, this observed decrease likely represents a true decrease in the occurrence of AHT during the COVID-19 pandemic.
Evidence Rating Level: 2 (Good)
Study Rundown: Since the onset of the COVID-19 pandemic in the U.S. there have been fewer reports to child protective services and emergency room visits for child maltreatment. This has led to the concern that children experiencing maltreatment are not being evaluated as frequently. In this study, researchers examined hospitalizations specifically for AHT during the COVID-19 pandemic. Overall, there were significantly fewer mean monthly admissions for AHT seen during the first months of the COVID-19 pandemic when compared to years prior. The main limitation of the study is that it relied on diagnostic coding, which is often unreliable, to identify cases of AHT. Results likely represent a true decline in cases of AHT during this time period, as it would be unlikely for caregivers to avoid bringing a child who experienced AHT to medical attention. Reasons behind this trend require further investigation.
Relevant Reading: Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020
In-Depth [cross-sectional study]: This study included 750 children under age 5 years who were hospitalized for AHT between March 11 and September 30, 2017 – 2020. March 11 was used as the start date because it was designated as the start of the COVID-19 pandemic by the World Health Organization. Number of hospitalizations as well as individual patient data were gathered from 49 U.S. hospitals in the Pediatric Health Information System database. Hospitalizations for AHT were defined as those associated with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for both confirmed child abuse and head trauma. Those associated with codes for suspected child abuse, motor vehicle accidents, or falls were excluded. Mean monthly admissions for AHT were lower in 2020 (19.1±2.9) compared to 2017 (29.1±4.2), 2018 (33.4±6.3), and 2019 (30.9±2.3). Median IQR number of days spent in hospital was also significantly shorter in patients hospitalized in 2020 (5) when compared with 2017-2019 (7) (P = 0.004). Other characteristics including patient age, gender, age, payor, race, ICU or ventilator use, presence of subdural or hemorrhage, and mortality did not vary significantly between years.
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