Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown

Abstract

Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown.

Objective: To assess the number, type and outcome of radiological investigations for children presenting to hospital with suspected physical abuse (SPA; including abusive head trauma) during the first national COVID-19 enforced lockdown compared with the prelockdown period.

Design: Multicentre, retrospective, observational, interrupted time series analysis.

Setting: Eight secondary/tertiary paediatric centres between January 2018 and July 2020 inclusive.

Participants: 1587 hospital assessed children undergoing radiographic skeletal surveys (SkS) and head CT imaging performed for SPA/child protection concerns.

Main outcome measures: Incidence and severity of fractures identified on SkS; head injury (composed of incidence rates and ratios of skull fracture, intracranial haemorrhage (ICH) and hypoxic ischaemic injury (HII)) on head CT imaging; and ratio of antemortem and postmortem SkS.

Results: 1587 SkS were performed: 1282 (81%) antemortem, 762 (48%) male, and positive findings in 582 (37%). Median patient age was 6 months. There were 1.7 fractures/child prelockdown versus 1.1 fractures/child during lockdown. There was no difference between positive/negative SkS rates, the absolute ratio of antemortem/postmortem SkS or absolute numbers of head injury occurring between January 2018 and February 2020 and the lockdown period April–July 2020. Likewise, prelockdown incidence and rates of skull fracture 30/244 (12%), ICH 28/220 (13%) and HIE 10/205 (5%) were similar to lockdown, 142/1304 (11%), 171/1152 (15%) and 68/1089 (6%), respectively.

Conclusion: The first UK COVID-19 lockdown did not lead to an increase in either the number of antemortem or postmortem radiological investigations performed for SPA, or the number or severity of fractures and intracranial injuries identified by these investigations.

Metadata

Authors/Creators:	Stivaros, S. Paddock, M. https://orcid.org/0000-0003-4508-8803 Rajai, A. Cliffe, H. Connolly, D.J.A. Dineen, R.A. Dixon, R. Edwards, H. Evans, E. Halliday, K. Jackson, K. Landes, C. Oates, A.J. Stoodley, N. Offiah, A.C. https://orcid.org/0000-0001-8991-5036
Copyright, Publisher and Additional Information:	© Author(s) (or their employer(s)) 2022. No commercial re-use. This is an author-produced version of a paper subsequently published in Archives of Disease in Childhood. This version is distributed under the terms of the Creative Commons Attribution-NonCommercial Licence (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You may not use the material for commercial purposes.
Keywords:	child abuse; child welfare; COVID-19; paediatrics; child protective services
Dates:	Accepted: 28 December 2021 Published (online): 17 February 2022
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Department of Oncology (Sheffield)
Depositing User:	Symplectic Sheffield
Date Deposited:	21 Apr 2022 10:43
Last Modified:	19 Dec 2022 16:55
Status:	Published
Publisher:	BMJ
Refereed:	Yes
Identification Number:	https://doi.org/10.1136/archdischild-2021-323444
Related URLs:	Author

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Rate and severity of radiological features of physical abuse in children during the first UK-wide COVID-19 enforced national lockdown

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