Incidence and Economic Evaluation of Pediatric Abusive Head Trauma with Retinal Hemorrhage During the COVID-19 Pandemic

Background: Pediatric abusive head trauma (AHT), is a subtype of domestic violence resulting from non-accidental shaking of the head or impact trauma. AHT is commonly associated with retinal hemorrhages (RH), which are present in 75-90% of cases. While domestic violence generally has increased since the onset of the COVID-19 pandemic, no study has evaluated the incidence of pediatric AHT with retinal hemorrhages during the first 12 months of the pandemic. 

Hypothesis: We hypothesize that if WFBMC experienced an increase in AHT during the COVID-19 pandemic, the incidence of RH also increased relative to pre-pandemic levels.

Methods: Retrospective chart review  

Results: At a single trauma center, the demographics, ocular findings, and associated non-ocular injuries were similar between pediatric AHT with RH patients seen over the first 12 months of the COVID-19 pandemic compared to those seen over the preceding three years. The incidence during the 12-month period immediately after COVID-19 induced social isolation was 0.92 cases/month, a 43.5% increase. 

Conclusions: The incidence of AHT with RH may have increased over the study period. The impact to individual patients and society of such an increase is profound. Using a previously published vision centric economic model, the societal costs of such an increase range from $1,925,000-$3,795,000 in 12 months at a single trauma center.