Impact on the incidence of suspected physical abuse in children under 24 months of age during a global pandemic: A multi-centre Irish regional retrospective cross-sectional analysis

Abstract

Objectives: The advent of the COVID-19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED attendance fell dramatically during the period. We reviewed data to determine whether there was an increase in presentations of SPA during periods of social restrictions.

Methods: The National Integrated Medical Imaging Service was searched for all skeletal survey examinations performed between the dates of the 1 March 2016 and 28 Feb 2021 for studies performed in cases of SPA. Electronic records of attendance were extracted from the emergency department administrative system at the three paediatric emergency departments which serve the 400,000 children regionally. The data were reviewed to determine if SPA presentations increased during restriction periods.

Results: 311 individual paediatric patients aged 24 months and under were referred for SPA skeletal survey during the study period. During the 2020/2021 period, 60 children were referred for SPA workup and there was no statistically significant difference between monthly referrals (mean 5, sd 2.92) in this period and matched periods over the preceding 4 years (mean 5.23, sd 2.69).

Conclusions: The incidence of SPA did not increase during the period of national restrictions during the COVID-19 pandemic.

Advances in knowledge: Periods of social restrictions taken to protect the public health during a pandemic do not result in short term increases in suspected physical abuse in the regional paediatric population.

Figure 1.

Trend in skeletal surveys per annum over the 5-year study period by age (all ages)

Figure 2.

Skeletal surveys per annum over the 5-year study period (children aged 24 months and under)

Figure 3.

Monthly attendance at ED by children aged 24 months and under: all reasons and injury

Figure 4.

Monthly Skeletal surveys and injury presentations to the ED by children aged 24 months and under

Figure 5.

Box plot of monthly ED attendance

Figure 6.

Box plot of monthly ED attendance for injury

Figure 7.

Box plot of monthly skeletal surveys referred for SPA

Figure 8.

Anteroposterior (AP) (a) and lateral (b) views of the right femur of a 3 months old female. The images demonstrate a transverse fracture through the right mid femoral shaft. There is posterior displacement of the distal fracture fragment. On the follow-up imaging (c) performed one month after the initial study, exuberant callous formation can be seen at the fracture site indicative of healing

Figure 9.

AP clavicle (a) and chest radiograph (b) of a 5-month-old male. There is a fracture of the middle third of the left clavicle with surrounding periosteal reaction and new bone formation indicative of healing

Figure 10.

Chest radiograph of a 4-month-old male. There are healing fractures (arrows) of the anterior aspects of the left seventh and eight ribs

Figure 11.

Oblique AP (a) and lateral (b) views of the right radius and ulna of a 9-month-old female. There are transverse fractures through the midshaft of the right radius and ulna, with slight apex dorsal angulation. The radius fracture is consistent with a greenstick fracture

Figure 12.

AP view of the right distal radius and ulna of a 14-month-old male. There is a buckle fracture (arrow) of the distal metaphysis of the right radius

Figure 13.

MRI brain of a 3 months old female including axial susceptibility-weighted imaging (SWI) (a), coronal FLAIR (b) and axial diffusion-weighted imaging (DWI) (C). On SWI there are serpiginous foci of low signal in places of the cerebral convexities suggesting torn bridging cerebral veins. A thin sliver of subdural haematoma over the left cerebral convexity can be appreciated on the coronal image. There are extensive regions of abnormal diffusion restriction (c) suggesting infarction secondary to hypoxic ischaemic insult