Prevalence, severity, and neurosurgical management of abusive head trauma during the COVID-19 pandemic

OBJECTIVE Reports published during the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) pandemic suggest that hospitals potentially experienced an increased incidence in the presentation of abusive head trauma (AHT) in children; however, it remains unknown if the pandemic influenced the severity or need for neurosurgical intervention during this time.METHODS This study is a post hoc analysis of a prospectively collected database of pediatric patients who sustained traumatic head injuries from 2018 to 2021 and were treated at the Children's Hospital of Pittsburgh that was screened for concern of AHT at the time of presentation. Pairwise univariate analysis of AHT prevalence, Glasgow Coma Scale (GCS) score, intracranial pathology, and neurosurgical interventions was performed to investigate differences before, during, and after the initial lockdown in Pennsylvania, which was defined as March 23, 2020, to August 26, 2020.RESULTS Of 2181 pediatric patients who presented with head trauma, 263 (12.1%) with AHT were identified. Preva- lence of AHT did not differ during (12.4% before vs 10.0% during, p = 0.31) or following (12.2% after, p = 0.92) lockdown. Need for neurosurgery after AHT remained unchanged during lockdown (10.7% before vs 8.3% during, p = 0.72) and after (10.5% after, p = 0.97). Patients did not differ in terms of sex, age, or race between periods. Average GCS score was lower after lockdown (13.9 before vs 11.9 after, p = 0.008) but not during (12.3, p = 0.062). In this cohort, mortality associated with AHT was 4.8 times higher during lockdown (4.3% before vs 20.8% during, p = 0.002) and returned to pre-lockdown rates thereafter (7.8%, p = 0.27). The primary contributor to mortality was ischemic brain injury (5% before vs 20.8% during, p = 0.005). Patients were 5.5 times more likely to undergo decompressive hemicraniectomy in the months after lockdown compared with prior (1.2% vs 6.6%, p = 0.035).CONCLUSIONS The authors have presented the findings of the first study to examine the prevalence and neurosurgical management of AHT during the Sars-Cov-2 lockdown in Pennsylvania. The overall prevalence of AHT was not affected by lockdown; however, patients were more likely to experience mortality or traumatic ischemia during lockdown. The GCS score of AHT patients was significantly lower, and these patients were more likely to require decompressive hemi- craniectomy after the initial lockdown period.