Department of Pediatric Anesthesia and Intensive Care, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France.
Department of Pediatric Neurosurgery, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France.
JAMA Netw Open. 2022 Aug 1;5(8):e2226182. doi: 10.1001/jamanetworkopen.2022.26182.
The COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse.
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.
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.
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.
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.
人们担心 COVID-19 大流行以及采取的遏制和缓解措施会导致儿童虐待增加。
调查 COVID-19 大流行期间婴儿虐待性头部外伤 (AHT) 发病率和严重程度的趋势。
设计、地点和参与者：在一项对纵向、基于人群的队列研究的时间序列分析中，纳入了 2017 年 1 月至 2021 年 12 月期间因 AHT 而连续到巴黎大都会地区唯一的区域性儿科神经外科中心 Necker 儿童医院就诊的年龄在 12 个月以下的所有婴儿病例。AHT 定义为 1 个或多个硬膜下血肿，以及在社会、临床、生物学和放射学检查后多学科评估呈阳性。数据分析于 2022 年 1 月进行。
主要结果是 AHT 的每月发病率，使用泊松回归模型进行分析。次要结果包括死亡率和严重发病率，并使用逻辑回归和线性回归进行研究。脑积水的神经外科干预的每月发病率用作对照系列。
在 99 名患有 AHT 的婴儿中（中位数 [IQR] 年龄，4 [3-6] 个月；64 名男孩 [65%]），86 名婴儿中有 86 名（87%）患有桥静脉血栓形成，74 名婴儿中有 74 名（75%）患有视网膜出血，23 名婴儿中有 23 名（32%）有骨折，72 名婴儿中有 26 名（26%）有癫痫持续状态，99 名婴儿中有 20 名（20%）有皮肤损伤，99 名婴儿中有 53 名（54%）接受了神经外科干预，99 名婴儿中有 13 名（13%）死亡。与大流行前时期（2017-2019 年）相比，2020 年 AHT 发病率保持稳定（调整发病率比，1.02；95%CI，0.59-1.77），然后在 2021 年显著增加（调整发病率比，1.92；95%CI，1.23-2.99）。2021 年 AHT 的严重程度在死亡率方面恶化（优势比 9.39；95%CI，1.88-47.00）。其他次要结果和对照系列没有明显改变。
在这项队列研究中，巴黎大都市区在 COVID-19 大流行期间 AHT 的发病率和严重程度明显增加。这些结果表明需要临床意识和预防措施。
