Related Experiment Video
Updated: Jul 29, 2026
Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic
Nathan L Maassel1, Elena Graetz2, Eric B Schneider2
1Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Insights
The COVID-19 pandemic saw a significant decrease in hospitalizations for abusive head trauma (AHT) in young children. However, this trend may be temporary, with a later increase observed in infants.
Area of Science:
- Pediatric medicine
- Public health
- Epidemiology
Background:
- Child abuse, particularly abusive head trauma (AHT), is a serious concern.
- The COVID-19 pandemic has raised questions about its impact on child abuse rates and hospitalizations.
- Understanding pandemic-related trends in severe child abuse is crucial for targeted prevention.
Purpose of the Study:
- To analyze trends in abusive head trauma (AHT) hospitalizations before and during the COVID-19 pandemic.
- To assess changes in the severity and clinical characteristics of AHT cases during the pandemic.
- To identify potential shifts in AHT incidence that may require public health intervention.
Main Methods:
- A retrospective, multicenter, cross-sectional study analyzed data from 45 tertiary care children's hospitals.
- Data included 2380 hospitalizations of children younger than 5 years with codes for abuse and head trauma from 2016 to 2022.
- Interrupted time-series analysis examined monthly AHT hospitalizations before and after March 2020.
Main Results:
- A total of 2380 AHT hospitalizations were identified.
- Monthly AHT hospitalizations decreased by 25.4% during the pandemic compared to pre-pandemic levels.
- No significant differences in hospitalization severity or clinical characteristics were observed between the periods.
- A significant decrease in monthly AHT hospitalizations was noted at the pandemic's onset, particularly in infants under 1 year, followed by a temporal increase.
Conclusions:
- The study indicates a significant initial decrease in AHT hospitalizations following the COVID-19 pandemic's onset.
- Severity of AHT hospitalizations did not increase during the pandemic.
- The decrease in AHT hospitalizations may be transient, as evidenced by a later increase in infants, highlighting the need for ongoing monitoring.
Importance:
Several studies have demonstrated a decrease in the occurrence of child abuse in the US since the start of the COVID-19 pandemic. This finding has generated concern for missed cases due to the initial lockdowns and lack of childcare resources. Determining the association of the pandemic on hospitalizations for severe forms of abuse is essential to focus preventive efforts.
Objective:
To examine trends in abusive head trauma (AHT) before and during the COVID-19 pandemic.
Design, Setting, And Participants:
Retrospective, multicenter, repeated cross-sectional study, conducted January 1, 2016, through April 30, 2022, with data from tertiary care children's hospitals and contributors to the Pediatric Health Information System. Data were obtained for 2380 hospitalizations of children younger than 5 years with International Classification of Diseases, Tenth Revision, Clinical Modification codes for both abuse and head trauma.
Main Outcomes And Measures:
Monthly hospitalizations were analyzed using interrupted time-series analysis. Hospitalization severity (eg, intensive care unit stay) and clinical characteristics (subdural hemorrhages and retinal hemorrhages) were compared before and after the start of the pandemic.
Results:
We identified 2380 hospitalizations due to AHT (median age, 140 [IQR, 75.0-325.5] days) from 45 hospitals. The mean (SD) monthly incidence of AHT was 34.3 (5.8) before the COVID-19 pandemic compared with 25.6 (4.2) during COVID-19 (a 25.4% decrease). When the pre-COVID-19 and during COVID-19 periods were compared, there were no significant differences in severity or clinical characteristics. On interrupted time-series analysis, there was a significant decrease in the number of monthly hospitalizations (-8.1; 95% CI, -12.41 to -3.72; P < .001) in the first month of the pandemic. In the subgroup of children younger than 1 year, there was a significant decrease in monthly hospitalizations at the onset of the pandemic (-8.2; 95% CI, -12.02 to -4.43; P < .001) followed by a significant temporal increase across the COVID-19 period (P = .01).
Conclusions And Relevance:
The findings of this cross-sectional study suggest there was a significant decrease in monthly hospitalizations for AHT following the start of the pandemic in March 2020. Although there was no corresponding increase in hospitalization severity, the decrease during the pandemic may have been transient, as monthly hospitalizations for children younger than 1 year increased significantly over time during COVID-19, after the initial decrease.
Related Concept Videos
01:26Brain Abscess l: Introduction
01:28Traumatic Brain Injury l: Introduction