Change in Incidence and Severity of Abusive Head Trauma in the Paediatric Age Group Pre- and During COVID-19 Lockdown in the North East of England

Background: Abusive head trauma(AHT) is currently the accepted terminology that encompasses previously used terms such as non-accidental injury (NAI) or non-accidental head injury (NAHI) and shaken baby syndrome (SBS). It is AHT and its ocular manifestations that ophthalmologists are vital in identifying and reporting.

Objectives: To investigate whether there is a change in the incidence or severity of AHT pre- and during COVID-19 lockdown.

Participants and Settings: AHT cases reported between March–June 2019 and March–June 2020. Data will be collected from James Cook University Hospital, Middlesbrough NHS Foundation Trust.

Methods: A retrospective comparative study.

Main Outcome Measures:

• Comparison of total number of children reported to child protection services pre- and during lockdown.
• Severity of reported cases.
• Ophthalmic involvement.

Results: Of the pre-lockdown safeguarding referrals, 5/61 (8.19%) had confirmed AHT, and 4/40 (10%) of the during lockdown group were confirmed AHT. The absence of teachers was evident, as in the pre-lockdown group 40% (2) of referrals originated from schools compared to none during the lockdown period. Ophthalmic involvement was not present in any of the pre-lockdown cases and only 50% (2) of the during lockdown cases, with the appropriate proforma only used in one of these cases. Unfortunately, no further statistical testing was meaningful in light of the small sample size.

Conclusions: The loss of the early warning detection mechanism provided by schools and health visitors may have contributed to both the change in presentation and severity of cases during the lockdown. There is also a need for ophthalmology and paediatrics to collaborate to ensure AHT cases are thoroughly investigated and documented.