(904) Incidence Rates of Abusive Head Trauma Hospitalizations Preceding and During the COVID-19 Pandemic

Introduction: Conflicting reports exist on the COVID-19 pandemic's impact on abusive head trauma (AHT) hospitalizations. These varying incidence rates during the pandemic may be due to the societal changes that resulted from the COVID lockdowns. We aimed to determine trends in AHT hospitalizations in the years preceding COVID and during the pandemic (2018-2022). We hypothesized that the incidence of AHT hospitalizations would decrease in 2020 before returning to pre-pandemic levels.

Methods: We performed a nationwide retrospective cohort study of US children ≤5 with confirmed AHT in the Pediatric Health Information System (PHIS) dataset between 2018 and 2022. AHT was defined using the CDC definition of AHT from discharge ICD-10 codes. Yearly AHT incidence rates (per 100,000 persons) were determined using yearly population estimates from census data. We compared rate ratios between individual study years, pre-pandemic periods, intra-pandemic periods, and periods with and without mask mandates. Additionally, we investigated the impact of reported race and household income on AHT incidence changes.

Results: Pre-pandemic AHT incidence rate was 6.78 per 100,000 persons (2019). AHT incidence rate in 2020 was lower than 2019 (2020 rate=5.81; rate ratio=0.88, 95%CI 0.81 - 0.95). AHT incidence in 2021 returned to pre-pandemic levels (rate=6.94; rate ratio=0.95, CI 0.89 - 1.02). AHT incidence in 2022 was below pre-pandemic levels (2022 rate=5.79; rate ratio=0.88, CI 0.82-0.95). AHT rates during mask mandate periods were lower than pre-pandemic and intra-pandemic periods without mask mandates (rate ratio=0.95, CI 0.90 - 0.997, p=0.047). AHT rates decreased for both White (rate ratio=0.89, CI 0.70-1.00 p=0.045) and Black (rate ratio=0.70, CI 0.60-0.82, p=0.001) children from 2019 to 2020, while rates in Hispanic children were unchanged (rate ratio=1.11, CI 0.90 - 1.36, p=0.31). In all years, most AHT cases came from the 2nd income quintile.

Conclusions: AHT rate reduction occurred during the early and late pandemic and during mask mandate periods. However, AHT rates returned to pre-pandemic levels in 2021 before decreasing again in 2022. The role of pandemic specific factors on AHT may not be fully appreciated by yearly trends as pandemic conditions changed more rapidly.