Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

Trends in hospital encounters for child physical abuse through the COVID-19 pandemic

Child physical abuse did not increase early in the coronavirus disease 2019 (COVID-19) pandemic as anticipated. However, abuse epidemiology has not been evaluated during later periods of the pandemic. This study's objective was to compare the volume of hospital encounters (i.e., emergency department visits and hospitalizations) for abuse and injuries concerning for abuse at 42 US children's hospitals across three pandemic periods compared with prepandemic, during January 1, 2018 through June 30, 2023. Median monthly volumes of encounters as well as child- and encounter-level characteristics for each pandemic period were compared with pre-pandemic. Hospital encounters for abuse and injuries concerning for abuse remained relatively unchanged throughout the pandemic, including during the late-pandemic period when many pandemic-related economic and relief policies had been discontinued. Hispanic children, however, accounted for an increasing proportion of cases throughout the pandemic, indicating potential emerging demographic changes in child abuse epidemiology.

Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study

OBJECTIVE

To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic.

STUDY DESIGN

This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use.

RESULTS

1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (P < .001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (P < .001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; P < .001) increase in the utilization of pharmacological thromboprophylaxis.

CONCLUSIONS

This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.