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1.
Eur J Pediatr ; 181(6): 2433-2438, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1844369

ABSTRACT

The global COVID-19 pandemic prompted governments to impose unprecedented sanitary measures, such as social distancing, curfews, and lockdowns. In France and other countries, the first COVID-19 lockdown raised concerns about an increased risk of child abuse. Abusive head trauma (AHT) is one of the most serious forms of child abuse in children aged 0-24 months and constitutes the leading cause of death in children under 2 years of age. Subdural hemorrhage (SDH) is present in 89% of cases of AHT and constitutes one of the most specific, objective clinical presentations in the diagnosis of child abuse. In a French nationwide study, we sought to evaluate the potential impact of the first year of the COVID-19 pandemic on the incidence of hospital admissions for child abuse with SDH, relative to the two previous years. We conducted a nationwide, retrospective study of data in the French national hospital discharge summary database by applying the International Classification of Diseases (10th Revision) codes for SDH and for child abuse. After including children aged up to 24 months with a diagnosis of child abuse and/or SDH following hospital admission anywhere in France between January 1, 2018, and December 31, 2020, we compared the incidence of child abuse, the incidence of SDH + child abuse, and the demographic data for 2020 with the corresponding values for 2018 and 2019. There were no significant differences in the number of hospital admissions due to child abuse or SDH + child abuse between 2020 and the 2018/2019 control years. The incidence of SDH + child abuse was higher among boys than among girls. There were significantly fewer hospital admissions in May 2020 (p = 0.01) and significantly more in December 2020 (p = 0.03), relative to the same months in the two preceding years. There was a nonsignificant trend toward a lower incidence of hospital admission for child abuse in 2020, relative to 2019 (decrease: 6.4%) and 2018 (decrease: 7.6%). CONCLUSION: When considering children under the age of 24 months in France, the incidence of hospital admission for SDH in the context of child abuse was not significantly higher in 2020 than in the two previous years. WHAT IS KNOWN: • The impact of COVID-19 lockdown on child abuse and more specifically on subdural hemorrhage remains unknown. WHAT IS NEW: • There was no increase in hospitalizations for child abuse and AHT. • We found that boys are more often victims of child abuse and subdural hemorrhage among children aged less than 12 months.


Subject(s)
COVID-19 , Child Abuse , Craniocerebral Trauma , COVID-19/epidemiology , Child , Child Abuse/diagnosis , Communicable Disease Control , Craniocerebral Trauma/epidemiology , Craniocerebral Trauma/etiology , Female , France/epidemiology , Hematoma, Subdural/epidemiology , Hematoma, Subdural/etiology , Humans , Incidence , Infant , Male , Pandemics , Retrospective Studies
2.
World Neurosurg ; 154: e473-e480, 2021 10.
Article in English | MEDLINE | ID: covidwho-1376112

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health emergency. While most cases end in asymptomatic or minor illness, there is growing evidence that some COVID-19 infections result in nonconventional dire consequences. We sought to describe the characteristics of patients with intracranial hemorrhage who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Also, with the existing literature, we raise the idea of a possible association between SARS-CoV-2 infection and intracranial hemorrhage and propose possible pathophysiological mechanisms connecting the two. METHODS: We retrospectively collected and analyzed intracranial hemorrhage cases who were also positive for SARS-CoV-2 from 4 tertiary-care cerebrovascular centers. RESULTS: We identified a total of 19 patients consisting of 11 males (58%) and 8 females (42%). Mean age was 52.2, with 95% younger than 75 years of age. With respect to COVID-19 illness, 50% had mild-to-moderate disease, 21% had severe disease, and 20% had critical disease requiring intubation. Of the 19 cases, 12 patients had intraparenchymal hemorrhage (63%), 6 had subarachnoid hemorrhage (32%), and 1 patient had a subdural hematoma (5%). A total of 43% had an intracerebral hemorrhage score of 0-2 and 57% a score of 3-6. Modified Rankin Scale cores at discharge were 0-2 in 23% and 3-6 in 77%. The mortality rate was 59%. CONCLUSIONS: Our series sheds light on a distinct pattern of intracerebral hemorrhage in COVID-19-positive cases compared with typical non-COVID-19 cases, namely the severity of hemorrhage, high mortality rate, and the young age of patients. Further research is warranted to delineate a potential association between SARS-CoV-2 infection and intracranial hemorrhage.


Subject(s)
COVID-19/complications , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/etiology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/physiopathology , Female , Hematoma, Subdural/epidemiology , Hematoma, Subdural/etiology , Humans , Intracranial Hemorrhages/mortality , Intubation, Intratracheal , Male , Middle Aged , Retrospective Studies , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/etiology , Treatment Outcome , Young Adult
3.
Acta Neurochir (Wien) ; 163(7): 1829-1836, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1163057

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to severe containment measures to protect the population in France. The first lockdown modified daily living and could have led to a decrease in the frequency of severe traumatic brain injury (TBI). In the present study, we compared the frequency and severity of severe TBI before and during the first containment in Normandy. METHODS: We included all patients admitted in the intensive care unit (ICU) for severe TBI in the two tertiary neurosurgical trauma centres of Normandy during the first lockdown. The year before the containment served as control. The primary outcome was the number of patients admitted per week in ICU. We compared the demographic characteristics, TBI mechanisms, CT scan, surgical procedure, and mortality rate. RESULTS: The incidence of admissions for severe TBI in Normandy decreased by 33% during the containment. The aetiology of TBI significantly changed during the containment: there were less traffic road accidents and more TBI related to alcohol consumption. Patients with severe TBI during the containment had a better prognosis according to the impact score (p=0.04). We observed a significant decrease in the rate of short-term mortality related to severe TBI during the period of lockdown (p=0.02). CONCLUSIONS: Containment related to the COVID-19 pandemic has resulted in a modification of the mechanisms of severe TBI in Normandy, which was associated with a decline in the rate of short-term death in intensive unit care.


Subject(s)
Brain Injuries, Traumatic/mortality , COVID-19/epidemiology , Intensive Care Units , Pandemics , Alcohol Drinking/epidemiology , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/etiology , Brain Injuries, Traumatic/surgery , COVID-19/virology , Female , France/epidemiology , Hematoma, Subdural/complications , Hematoma, Subdural/epidemiology , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/physiology , Treatment Outcome
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