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

Stavros Stivaros; Michael Paddock; Azita Rajai; Helen Cliffe; Daniel Ja Connolly; Robert A Dineen; Rachel Dixon; Harriet Edwards; Emily Evans; Katherine Halliday; Kandise Jackson; Caren Landes; Adam J Oates; Neil Stoodley; Amaka C Offiah

doi:10.1136/archdischild-2021-323444

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

Arch Dis Child. 2022 Jun;107(6):575-581. doi: 10.1136/archdischild-2021-323444. Epub 2022 Feb 17.

Authors

Stavros Stivaros^{1

2}, Michael Paddock^{3

4}, Azita Rajai^{5

6}, Helen Cliffe⁷, Daniel Ja Connolly⁸, Robert A Dineen^{9

10}, Rachel Dixon¹¹, Harriet Edwards^{12

13}, Emily Evans¹⁴, Katherine Halliday⁹, Kandise Jackson¹⁵, Caren Landes¹², Adam J Oates¹⁶, Neil Stoodley¹⁷, Amaka C Offiah^{4

8}

Affiliations

¹ Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK stavros.stivaros@manchester.ac.uk.
² Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK.
³ Department of Medical Imaging, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK.
⁴ Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK.
⁵ Centre for Biostatistics, Division of Population Health, Manchester Academic Science Centre, The University of Manchester, Manchester, UK.
⁶ Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK.
⁷ Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK.
⁸ Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK.
⁹ Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁰ NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
¹¹ Department of Paediatric Radiology, Manchester University NHS Foundation Trust, Manchester, UK.
¹² Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK.
¹³ Department of Radiology, Aintree University Hospital, Liverpool, Merseyside, UK.
¹⁴ Department of Radiology, University Hospital Coventry, Coventry, UK.
¹⁵ Department of Radiology, Royal Oldham Hospital, Oldham, Greater Manchester, UK.
¹⁶ Department of Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK.
¹⁷ Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK.

PMID: 35177407
DOI: 10.1136/archdischild-2021-323444

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.

Keywords: COVID-19; child abuse; child protective services; child welfare; paediatrics.

MeSH terms

COVID-19* / epidemiology
Child
Child Abuse* / diagnosis
Communicable Disease Control
Craniocerebral Trauma* / diagnostic imaging
Craniocerebral Trauma* / epidemiology
Craniocerebral Trauma* / etiology
Female
Humans
Infant
Male
Physical Abuse
Retrospective Studies
Skull Fractures* / diagnostic imaging
Skull Fractures* / epidemiology
Skull Fractures* / etiology
United Kingdom / epidemiology