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Pediatrics

Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: August 30, 2022

Original Investigation

Article Information and Disclosures

Alina-Marilena Lãzãrescu, MD¹;

Sandro Benichi, MD²;

Thomas Blauwblomme, MD, PhD²;

Kévin Beccaria, MD, PhD²;

Marie Bourgeois, MD²;

Charles-Joris Roux, MD³;

Estelle Vergnaud, MD¹;

Juliette Montmayeur, MD¹;

Philippe Meyer, MD¹;

Jérémie F. Cohen, MD, PhD^4,5;

Martin Chalumeau, MD, PhD^4,5;

Flora Blangis, MPH^4,5;

Gilles Orliaguet, MD, PhD^1,6

Author Affiliations

¹Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
²Department of Pediatric Neurosurgery, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
³Department of Pediatric Radiology, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
⁴Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Institut National de la Santé et de la Recherche Medicale, Paris, France
⁵Child Protection Unit, Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
⁶Unit EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Université Paris Cité, Paris, France

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Key Points

Question Did the incidence of abusive head trauma in infants in the Paris metropolitan area increase during the first 2 years of the COVID-19 pandemic (2020-2021) compared with the prepandemic period (2017-2019)?

Findings In a time-series analysis of a cohort study including 99 infants, abusive head trauma incidence was stable in 2020 and then nearly doubled, a significant increase, in 2021.

Meaning These findings suggest that the marked increase in abusive head trauma incidence during the COVID-19 pandemic in the Paris metropolitan area should prompt clinical awareness and preventive actions.

Abstract

Importance The COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse.

Objective To investigate the trend of abusive head trauma (AHT) incidence and severity in infants during the COVID-19 pandemic.

Design, Setting, and Participants In a time-series analysis of a longitudinal, population-based, cohort study, all consecutive cases of AHT in infants younger than 12 months old referred between January 2017 and December 2021 to Necker Hospital for Sick Children, the single regional pediatric neurosurgery center for the Paris metropolitan area, were included. AHT was defined as 1 or more subdural hemorrhage and a positive multidisciplinary evaluation after a social, clinical, biological, and radiological workup. Data were analyzed from January to March 2022.

Main Outcomes and Measures The primary outcome was the monthly incidence of AHT, which was analyzed using Poisson regression modeling. Secondary outcomes included mortality and severe morbidity and were studied with logistic and linear regressions. The monthly incidence of neurosurgical interventions for hydrocephalus was used as a control series.

Results Among the 99 included infants with AHT (median [IQR] age, 4 [3-6] months; 64 boys [65%]), 86 of 99 (87%) had bridging vein thrombosis, 74 of 99 (75%) had retinal hemorrhages, 23 of 72 (32%) had fractures, 26 of 99 (26%) had status epilepticus, 20 of 99 (20%) had skin injuries, 53 of 99 (54%) underwent neurosurgical interventions, and 13 of 99 (13%) died. Compared with the prepandemic period (2017-2019), AHT incidence was stable in 2020 (adjusted incidence rate ratio, 1.02; 95% CI, 0.59-1.77) and then significantly increased in 2021 (adjusted incidence rate ratio, 1.92; 95% CI, 1.23-2.99). The severity of AHT worsened in 2021 in terms of mortality (odds ratio 9.39; 95% CI, 1.88-47.00). Other secondary outcomes and the control series were not significantly modified.

Conclusions and Relevance In this cohort study, a marked increase in AHT incidence and severity occurred during the COVID-19 pandemic in the Paris metropolitan area. These results suggest the need for clinical awareness and preventive actions.

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Article Information

Accepted for Publication: June 2, 2022.

Published: August 30, 2022. doi:10.1001/jamanetworkopen.2022.26182

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Lãzãrescu AM et al. JAMA Network Open.

Corresponding Author: Flora Blangis, MPH, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Institut National de la Santé et de la Recherche Medicale, 53 Avenue de l'Observatoire, 75014 Paris, France (flora.blangis@inserm.fr).

Author Contributions: Dr Lãzãrescu and Ms Blangis had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Lãzãrescu, Benichi, and Orliaguet and Ms Blangis contributed equally to this work.

Concept and design: Lãzãrescu, Benichi, Blauwblomme, Beccaria, Bourgeois, Roux, Vergnaud, Montmayeur, Meyer, Orliaguet.

Acquisition, analysis, or interpretation of data: Lãzãrescu, Benichi, Blauwblomme, Cohen, Chalumeau, Blangis.

Drafting of the manuscript: Lãzãrescu, Benichi, Blauwblomme, Cohen, Chalumeau, Blangis.

Critical revision of the manuscript for important intellectual content: Blauwblomme, Beccaria, Bourgeois, Roux, Vergnaud, Montmayeur, Meyer, Orliaguet.

Statistical analysis: Cohen, Chalumeau, Blangis.

Obtained funding: Chalumeau, Blangis.

Supervision: Lãzãrescu, Benichi, Blauwblomme, Cohen, Chalumeau.

Conflict of Interest Disclosures: None reported.

Funding/Support: Ms Blangis and Dr Chalumeau received external funding for this study from the Association Française de Pédiatrie Ambulatoire, Hôpitaux Universitaires du Grand Ouest, Mustela Foundation, and Sauver la Vie–Fondation Paris Descartes prizes.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Elise Launay, MD, PhD (Nantes University), provided valuable advice. She was not compensated for her services.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.