234 - Incidence of Abusive Head Trauma During the COVID-19 Pandemic in Western Pennsylvania

Poster Number: 234
Publication Number: 234.402

Dominic Cercone, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States; Rachel Berger, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Mioara Manole, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Jane K. Soung, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Kathleen Noorbakhsh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Abusive head trauma (AHT) is the leading cause of death from non-accidental trauma in children. Lifestyle disruptions during the COVID-19 pandemic, including work, child care and school closures along with elevated unemployment rates added to family stressors, posing potential increased risk for family violence. Reports regarding the impact of the COVID-19 pandemic on rates of AHT are limited and with conflicting results. There have been no reports thus far describing the incidence of AHT during the entire first year of the COVID-19 pandemic.

Objective: To determine the incidence and clinical characteristics of AHT admissions during the first year of the COVID-19 pandemic compared to the two prior years.

Design/Methods: We performed a cohort study of all patients < 5 years old admitted to a single pediatric tertiary care center from March 11, 2018 to March 10, 2021. Patients were prospectively identified and retrospectively reviewed. AHT was defined as any injury to the skull or intracranial contents due to blunt impact or shaking deemed to be highly concerning or definitive for abuse by the UPMC Children’s Hospital of Pittsburgh Child Protection Team. The following data were extracted: patient demographics, length of stay, intensive care unit (ICU) admission, physical examination, results of all radiologic evaluations, EEG results, retinal exam findings, mortality, and disposition. Data were compared for the two years before the pandemic (March 2018 to March 2020) and the first year of the pandemic (March 2020 to March 2021). Statistical comparisons of patient characteristics were performed using Mann-Whitney U, Chi-square, or Fisher’s exact tests.

Results: There were 30 patients admitted with AHT during the pandemic and 62 combined patients during the two pre-pandemic years. The mortality rate was 26.7% (n=8) during the pandemic vs. 1.6% (n=1) pre-pandemic (p < .001). The pandemic saw a significant increase in retinal hemorrhages (p=.001) and abnormalities seen on both EEG (p=.012) and cervical spine imaging (p=.005). A similar rate of ICU admissions and abnormal physical examination and skeletal survey findings were noted for AHT patients during the pandemic vs. pre-pandemic years.Conclusion(s): This study showed a similar number of yearly AHT admissions during the COVID-19 pandemic compared to the two previous years. There was a significant increase in mortality along with retinal hemorrhages and abnormalities seen on both EEG and cervical spine imaging for AHT patients during the pandemic. These data suggest an increased severity of AHT encounters during the pandemic.
DC.CV.pdf
Table 2Clinical Characteristics and Outcomes