ORIGINAL
Introdução: a pandemia pela COVID-19 impactou as políticas públicas de saúde em todo o mundo produzindo desemprego e aumento do risco de traumatismo por abuso na população pediátrica. O fechamento temporário das escolas durante a pandemia, apresenta o potencial de relacionar-se ao aumento dos traumas infantis, especialmente aqueles relacionados a traumas por causas violentas em crianças menores de um ano as quais são vulneráveis as agressões, bem como o aumento da mortalidade por traumatismo cranioencefálico (TCE) acidental. Assim, a hipótese desse estudo é que o isolamento social pode ter aumentado a mortalidade por causas violentas, como o TCE por abuso. Objetivo: avaliar o impacto da pandemia pela COVID-19 na mortalidade pelo TCE não acidental em menores de um ano. Métodos: o estudo analisa dados relativos aos óbitos dos pacientes com idade abaixo de um ano devido a causas externas e por violência, obtidos a partir do banco de dados do DATASUS em todos os estados brasileiros, separados em três períodos: pré-pandemia (2018-2020), pandemia (2020-2023) e pós-pandemia (após maio de 2023). Resultados: no período pré-pandemia, houve média mensal de 3,1 óbitos por TCE. Durante a pandemia, 2,9 óbitos/mês e no período pós-pandemia, 3,75 óbitos/mês. A média de óbitos por agressões antes da pandemia foi de 0,75 óbitos/mês, durante a pandemia 0,57 óbitos e no pós-pandemia 0,75 óbitos. Conclusão: o estudo sugere que durante a pandemia pelo COVID-19 ocorreu redução na incidência de óbitos devido a TCE por abuso em menores que um ano no Brasil.
Introduction: the COVID-19 pandemic has impacted public health policies around the world producing unemployment and increasing the risk of trauma for abuse in the pediatric population. The temporary closing of schools during the pandemic raises concerns about a possible increase in injuries, especially those related to trauma from violent causes, in children under one year of age, which was more prone to suffer this type of injury and evaluate to increase in mortality from traumatic brain injury (TBI). Thus, social isolation may have increased mortality from violent causes, such as non-accidental TBI. Objective: to evaluate the impact of COVID-19 pandemic on mortality from non-accidental TBI in children under one year old. Methods: the study analyzes data relating to deaths of patients aged under one year due to external causes and violence, deaths from the DATASUS database in all Brazilian states, separate into three periods: Pre-pandemic (2018-2020), Pandemic (2020-2023) and post-pandemic (after May 2023). Results: in the pre-pandemic period, there was a monthly average of 3.1 deaths due to intracranial trauma. During the pandemic, 2.9 deaths/month and in the post-pandemic period, 3.75 deaths/month. The average number of deaths from aggression before the pandemic was 0.75 deaths/month, during the pandemic 0.57 deaths and post-pandemic 0.75 deaths. Conclusion: the study suggests that during the COVID-19 pandemic a decrease of deaths was observed due to abusive head trauma in children under one year of age in Brazil.
1. WORLD HEALTH ORGANIZATION. Coronavirus disease 2019 (COVID-19) situation report - 93. Geneva: WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situationreports/20200422-sitrep-93-covid-19.pdf. Accessed: 11/3/2023.
2. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020;25(4):2000058. http://dx.doi. org/10.2807/1560-7917.ES.2020.25.4.2000058. PMid:32019669.
3. Chan JFW, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514- 23. http://dx.doi.org/10.1016/S0140-6736(20)30154-9. PMid:31986261.
4. Furtado LMF, Val JAC Fo, Santos AR, et al. Pediatric minor head trauma in Brazil and external validation of PECARN rules with a costeffectiveness analysis. Brain Inj. 2020;34(11):1467-71. http://dx.doi.or g/10.1080/02699052.2020.1802667. PMid:32791018.
5. Rodriguez CM, Lee SJ, Ward KP, Pu DF. The perfect storm: hidden risk of child maltreatment during the Covid-19 pandemic. Child Maltreat. 2021;26(2):139-51. http://dx.doi.org/10.1177/1077559520982066. PMid:33353380.
6. 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. http://dx.doi.org/10.1136/ archdischild-2020-319872. PMid:32616522.
7. Martinkevich P, Larsen LL, Graesholt-Knudsen T, et al. Physical child abuse demands increased awareness during health and socioeconomic crisis like COVID-19. Acta Orthop. 2020;91(5):527-33. http://dx.doi. org/10.1080/17453674.2020.1782012. PMid:32573297.
8. Sanford EL, Zagory J, Blackwell JM, Szmuk P, Ryan M, Ambardekar A. Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital. J Pediatr Surg. 2021;56(5):918-22. http:// dx.doi.org/10.1016/j.jpedsurg.2021.01.020. PMid:33516579.
9. Seddighi H, Salmani I, Javadi MH, Seddighi S. Child abuse in natural disasters and conflicts: a systematic review. Trauma Violence Abuse. 2021;22(1):176-85. http://dx.doi.org/10.1177/1524838019835973. PMid:30866745.
10. MINISTÉRIO DA SAÚDE. Diretrizes de atenção à reabilitação da pessoa com traumatismo cranioencefálico. Brasília: Ministério da Saúde; 2015. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/ diretrizes_atencao_reabilitacao_pessoa_traumatisco_cranioencefalico. pdf. Accessed: 1/14/2024.
11. Silva NS, Portella ALM, Freitas DM, et al. Traumatic brain injury in children and adolescents in Brazil: an epidemiological approach. Res Soc Dev. 2023;12(7):e3112742434. http://dx.doi.org/10.33448/ rsd-v12i7.42434.
12. Langlois JA, Rutland-Brown W, Thomas KE. The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil. 2005;20(3):229-38. http://dx.doi. org/10.1097/00001199-200505000-00006. PMid:15908823.
13. Maassel NL, Asnes AG, Leventhal JM, Solomon D. Hospital admissions for abusive head trauma at children’s hospitals during COVID-19. Pediatrics. 2021;148(1):e2021050361. http://dx.doi. org/10.1542/peds.2021-050361. PMid:33879521.
14. Rey-Salmon C, de Boissieu P, Teglas JP, Adamsbaum C. Abusive head trauma in day care centers. Pediatrics. 2020;146(6):e2020013771. http://dx.doi.org/10.1542/peds.2020-013771. PMid:33172921.
15. Bessoff KE, Han RW, Cho M, et al. Epidemiology of pediatric trauma during the COVID-19 pandemic shelter in place. Surgery Open Science. 2021;6:5-9. http://dx.doi.org/10.1016/j.sopen.2021.06.001. PMid:34308327.
16. Lee SJ, Ward KP, Lee JY, Rodriguez CM. Parental social isolation and child maltreatment risk during the COVID-19 pandemic. J Fam Violence. 2022;37(5):813-24. http://dx.doi.org/10.1007/s10896-020- 00244-3. PMid:33462526.
17. MINISTÉRIO DO DESENVOLVIMENTO E ASSISTÊNCIA SOCIAL, FAMÍLIA E COMBATE À FOME. Em novo recorde, mais de 21,6 milhões de famílias recebem o Auxílio Brasil em dezembro. Available from: https://www.gov.br/mds/pt-br/noticias-e-conteudos/ desenvolvimento-social/noticias-desenvolvimento-social/em-novorecorde-mais-de-21-6-milhoes-de-familias-recebem-o-auxiliobrasil-em-dezembro#:~:text=Transfer%C3%AAncia%20de%20 Renda-,Em%20novo%20recorde%2C%20mais%20de%2021%2C6%20 milh%C3%B5es%20de%20fam%C3%ADlias,o%20Aux%C3%ADlio%20 Brasil%20em%20dezembro. Accessed: 11/4/2023.
18. Wong JYH, Wai AKC, Wang MP, et al. Impact of COVID-19 on child maltreatment: income instability and parenting issues. Int J Environ Res Public Health. 2021;18(4):1501. http://dx.doi.org/10.3390/ ijerph18041501. PMid:33562467.
19. Sallas J, Elidio GA, Costacurta GF, et al. Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020. Epidemiol Serv Saude. 2022;31(1):e2021303. http://dx.doi.org/10.1590/s1679-49742022000100011. PMid:35508012.
20. Levandowski ML, Stahnke DN, Munhoz TN, Von Hohendorff J, Salvador-Silva R. Impacto do distanciamento social nas notificações de violência contra crianças e adolescentes no Rio Grande do Sul, Brasil. Cad Saude Publica. 2021;37(1):e00140020. http://dx.doi.org/10.1590/0102- 311x00140020. PMid:33440409.
1 MS, Medical student, Department of Medicine, Pontifícia Universidade Católica de Minas Gerais, Contagem, MG, Brazil.
2 MS, Medical student, Department of Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.
3 MD, Doctorate student in Neuroscience, Department of Pediatric Neurosurgery, Hospital Vila da Serra, Oncoclínicas, Nova Lima, MG, Brazil
Received Nov 13, 2023
Accepted Jan 14, 2024
