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

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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.


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.

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