{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:58:20Z","timestamp":1790521100491,"version":"4.1.0"},"reference-count":11,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Reports published during the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) pandemic suggest that hospitals potentially experienced an increased incidence in the presentation of abusive head trauma (AHT) in children; however, it remains unknown if the pandemic influenced the severity or need for neurosurgical intervention during this time.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study is a post hoc analysis of a prospectively collected database of pediatric patients who sustained traumatic head injuries from 2018 to 2021 and were treated at the Children\u2019s Hospital of Pittsburgh that was screened for concern of AHT at the time of presentation. Pairwise univariate analysis of AHT prevalence, Glasgow Coma Scale (GCS) score, intracranial pathology, and neurosurgical interventions was performed to investigate differences before, during, and after the initial lockdown in Pennsylvania, which was defined as March 23, 2020, to August 26, 2020.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 2181 pediatric patients who presented with head trauma, 263 (12.1%) with AHT were identified. Prevalence of AHT did not differ during (12.4% before vs 10.0% during, p = 0.31) or following (12.2% after, p = 0.92) lockdown. Need for neurosurgery after AHT remained unchanged during lockdown (10.7% before vs 8.3% during, p = 0.72) and after (10.5% after, p = 0.97). Patients did not differ in terms of sex, age, or race between periods. Average GCS score was lower after lockdown (13.9 before vs 11.9 after, p = 0.008) but not during (12.3, p = 0.062). In this cohort, mortality associated with AHT was 4.8 times higher during lockdown (4.3% before vs 20.8% during, p = 0.002) and returned to pre-lockdown rates thereafter (7.8%, p = 0.27). The primary contributor to mortality was ischemic brain injury (5% before vs 20.8% during, p = 0.005). Patients were 5.5 times more likely to undergo decompressive hemicraniectomy in the months after lockdown compared with prior (1.2% vs 6.6%, p = 0.035).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors have presented the findings of the first study to examine the prevalence and neurosurgical management of AHT during the Sars-Cov-2 lockdown in Pennsylvania. The overall prevalence of AHT was not affected by lockdown; however, patients were more likely to experience mortality or traumatic ischemia during lockdown. The GCS score of AHT patients was significantly lower, and these patients were more likely to require decompressive hemicraniectomy after the initial lockdown period.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.2.peds2317","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T02:49:42Z","timestamp":1680317382000},"page":"19-25","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence, severity, and neurosurgical management of abusive head trauma during the COVID-19 pandemic"],"prefix":"10.3171","volume":"32","author":[{"given":"Jasmine L.","family":"Hect","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anmol","family":"Almast","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Simon","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Shoemaker","sequence":"additional","affiliation":[{"name":"Benedum Trauma Program, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurosurgery, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Pediatrics","first-page":"e2021050361","article-title":"Hospital admissions for abusive head trauma at children\u2019s hospitals during COVID-19","volume":"148","author":"Maassel NL","year":"2021","unstructured":"Maassel NL, Asnes AG, Leventhal JM, Solomon DG. Hospital admissions for abusive head trauma at children\u2019s hospitals during COVID-19. Pediatrics. 2021;148(1):e2021050361.33879521"},{"issue":"49","key":"b2","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1841","article-title":"Trends in U.S. emergency department visits related to suspected or confirmed child abuse and neglect among children and adolescents aged <18 years before and during the COVID-19 pandemic\u2014United States, January 2019-September 2020","volume":"69","author":"Swedo E","year":"2020","unstructured":"Swedo E, Idaikkadar N, Leemis R,  Trends in U.S. emergency department visits related to suspected or confirmed child abuse and neglect among children and adolescents aged <18 years before and during the COVID-19 pandemic\u2014United States, January 2019-September 2020. MMWR Morb Mortal Wkly Rep. 2020;69(49):1841\u20131847.33301436"},{"issue":"4","key":"b3","series-title":"J Pediatr Surg","first-page":"726","article-title":"Effect of the COVID-19 pandemic on presentation and severity of traumatic injury due to physical child abuse across US children\u2019s hospitals","volume":"57","author":"De Boer C","year":"2022","unstructured":"De Boer C, Ghomrawi HM, Bouchard ME, Linton SC, Tian Y, Abdullah F. Effect of the COVID-19 pandemic on presentation and severity of traumatic injury due to physical child abuse across US children\u2019s hospitals. J Pediatr Surg. 2022;57(4):726\u2013731.34334186"},{"issue":"4","key":"b4","series-title":"J Pediatr","first-page":"716","article-title":"Risk factors for mortality in children with abusive head trauma","volume":"161","author":"Shein SL","year":"2012","unstructured":"Shein SL, Bell MJ, Kochanek PM,  Risk factors for mortality in children with abusive head trauma. J Pediatr. 2012;161(4):716\u2013722.e1.22578583"},{"key":"b5","series-title":"City of Pittsburgh","article-title":"COVID-19 Updates","unstructured":"COVID-19 Updates. City of Pittsburgh. Accessed February 27, 2023.http:\/\/pittsburghpa.gov\/mayor\/covid-updates"},{"key":"b6","series-title":"ABC27.","article-title":"Timeline of a Year of COVID-19 in Pennsylvania","unstructured":"Timeline of a Year of COVID-19 in Pennsylvania. ABC27.Accessed February 27, 2023.https:\/\/www.abc27.com\/timeline-of-a-year-of-covid-19-in-pennsylvania\/"},{"issue":"3","key":"b7","series-title":"J Trauma","first-page":"187","article-title":"The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker SP","year":"1974","unstructured":"Baker SP, O\u2019Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187\u2013196.4814394"},{"issue":"4","key":"b8","series-title":"Pediatrics","first-page":"637","article-title":"Abusive head trauma during a time of increased unemployment: a multicenter analysis","volume":"128","author":"Berger RP","year":"2011","unstructured":"Berger RP, Fromkin JB, Stutz H,  Abusive head trauma during a time of increased unemployment: a multicenter analysis. Pediatrics. 2011;128(4):637\u2013643.21930535"},{"issue":"3","key":"b9","series-title":"Arch Dis Child","first-page":"e14","article-title":"Rise in the incidence of abusive head trauma during the COVID-19 pandemic","volume":"106","author":"Sidpra J","year":"2021","unstructured":"Sidpra J, Abomeli D, Hameed B, Baker J, Mankad K. Rise in the incidence of abusive head trauma during the COVID-19 pandemic. Arch Dis Child. 2021;106(3):e14.32616522"},{"issue":"Pt 2","key":"b10","series-title":"Child Abuse Negl","first-page":"104719","article-title":"Reporting of child maltreatment during the SARS-CoV-2 pandemic in New York City from March to May 2020","volume":"116","author":"Rapoport E","year":"2021","unstructured":"Rapoport E, Reisert H, Schoeman E, Adesman A. Reporting of child maltreatment during the SARS-CoV-2 pandemic in New York City from March to May 2020. Child Abuse Negl. 2021;116(Pt 2):104719."},{"key":"b11","series-title":"Child Abuse Negl","first-page":"105971","article-title":"Increased severity of abusive head trauma during the first year of the COVID-19 pandemic","volume":"135","author":"Cercone DJ","year":"2023","unstructured":"Cercone DJ, Berger RP, Manole MD, Soung JK, Coombs CM, Noorbakhsh KA. Increased severity of abusive head trauma during the first year of the COVID-19 pandemic. 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