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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
  1. Stavros Stivaros1,2,
  2. Michael Paddock3,4,
  3. Azita Rajai5,6,
  4. Helen Cliffe7,
  5. Daniel JA Connolly8,
  6. Robert A Dineen9,10,
  7. Rachel Dixon11,
  8. Harriet Edwards12,13,
  9. Emily Evans14,
  10. Katherine Halliday9,
  11. Kandise Jackson15,
  12. Caren Landes12,
  13. Adam J Oates16,
  14. Neil Stoodley17,
  15. Amaka C Offiah4,8
  1. 1 Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK
  2. 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. 3 Department of Medical Imaging, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  4. 4 Department of Oncology & Metabolism, Damer Street Building, The University of Sheffield, Sheffield, South Yorkshire, UK
  5. 5 Centre for Biostatistics, Division of Population Health, Manchester Academic Science Centre, The University of Manchester, Manchester, UK
  6. 6 Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
  7. 7 Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  8. 8 Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, UK
  9. 9 Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  10. 10 NIHR Nottingham Biomedical Research Centre, Nottingham, UK
  11. 11 Department of Paediatric Radiology, Manchester University NHS Foundation Trust, Manchester, UK
  12. 12 Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
  13. 13 Department of Radiology, Aintree University Hospital, Liverpool, Merseyside, UK
  14. 14 Department of Radiology, University Hospital Coventry, Coventry, UK
  15. 15 Department of Radiology, Royal Oldham Hospital, Oldham, Greater Manchester, UK
  16. 16 Department of Radiology, Birmingham Women’s and Children’s Hospitals NHS Foundation Trust, Birmingham, UK
  17. 17 Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Professor Stavros Stivaros, Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK; stavros.stivaros{at}manchester.ac.uk

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.

  • child abuse
  • child welfare
  • COVID-19
  • paediatrics
  • child protective services

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2021-323444

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • Twitter @ACOffiah

    • Presented at 8th International Pediatric Radiology (IPR) Congress, Rome, Italy, on 15th October, 2021.

    • Contributors Guarantor of integrity of the entire study: SS. Study concepts and design: SS, MP, HC, DJAC, RAD, KJ, CL, AJO and ACO. Literature research: SS, MP and ACO. Clinical/experimental studies: SS, MP, HC, DJAC, RAD, RD, HE, EE, KH, KJ, CL, AJO, NS and ACO. Data analysis: SS and AR. Statistical analysis: AR and SS. Manuscript preparation: SS, MP, AR, and ACO. Manuscript editing: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; RAD has received research grants from the NIHR, CCLG, MS Society, and Action for A-T; ACO has received research grants from the NIHR, The Children’s Hospital Charity, Alexion, and OfS; DJAC has received payment for expert testimony in relation to birth injury cases; SS, KH, CL, AJO, NS and ACO have received payment for expert testimony from Her Majesty’s Courts and/or the Police; CL and ACO have either been paid or reimbursed with an honorarium for lecturing and teaching on the subject of imaging in inflicted injury; SS and ACO have been paid for developing and delivering educational presentations for InfoMed; ACO does consultancy for Alexion and BioMarin; MP is a member of the ESPR Education Committee; ACO is the Chair of the ESPR Child Abuse Taskforce and the Skeletal Dysplasia Group for Teaching and Research; no other relationships or activities that could appear to have influenced the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.