Article Text

Download PDFPDF

436 Non-accidental injury and abusive head trauma in children – is the COVID-19 pandemic impacting teesside differently?
  1. Matthew Davidson,
  2. Shashwat Saran,
  3. Qasim Mansoor,
  4. Thomas Salisbury
  1. UK


Background An article published by Sidpra J et al, in ADC in July 2020 reported an increase of approximately 1500% in the incidence of abusive head trauma (AHT) in children, understandably shocking paediatricians nationally.

Objectives We wanted to see the impact of lockdown on referrals made to our hospital (University Hospital of North Tees, Stockton, UK) for children suspected to have non-accidental injuries (NAI) or AHT.

Methods We audited the records of children referred with suspected NAI during the first lockdown period (23rd of March to 4th of July 2020) and compared it with the preceding year (23rd of March to 4th of July 2019)

As children under two are more likely to suffer AHT, these cases were identified by two auditors and then a single auditor reviewed these case records in detail.

Results Total of thirty-one children in 2019 & twenty-five in 2020 were referred for Child Protection Medical Assessments. Eleven children - six in 2019 and five in 2020 - were less than two years old. Of these, four were girls and seven boys. Five children were less than three months old

Nine children were referred with suspicious bruising, one was the sibling of an index child with NAI and for one, an allegation was made of rough handling.

Two children with skull fractures and one with a rib fracture (on follow up scan) were identified on radiological investigations. Hematological investigations and ophthalmic findings were unremarkable for all the children.

All children were seen within 24 hours of a referral being made. In all cases, an interim report was provided on the same day and a final report within seven working days. All children were investigated as per RCPCH guidelines.

Seven out of eleven children referred for NAI assessment were concluded to have probable non-accidental injuries – three in 2019, and four in 2020.

Our neighbouring hospital received five and four referrals for suspected NAI in children under 2 years old in the same period of time in 2019 and 2020 respectively. One of these children in 2020 had retinal haemorrhages associated with AHT and a skull fracture.

Conclusions Our audit of children referred for NAI medical assessment does not suggest any significant difference between numbers in 2019 and 2020. This is in contrast with what colleagues from UCL, London have reported, and surprising given the high levels of socioeconomic deprivation in our area, which is usually associated with a higher incidence of child abuse.

In order to understand national trends, we recommend other areas of the United Kingdom to review their data to establish whether this pandemic and associated lockdowns are impacting children in Teesside differently.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.