Increased incidence of nonaccidental head trauma in infants associated with the economic recession

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Nonaccidental head trauma (NAHT) is a major cause of death in infants. During the current economic recession, the authors noticed an anecdotal increase in infants with NAHT without an increase in the overall number of infants admitted with traumatic injuries. An analysis was performed to determine whether there was an association between economic recession and NAHT.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>With Institutional Review Board approval, the trauma database was searched for NAHT in infants 0–2 years old during nonrecession (December 2001 to November 2007) and recession (December 2007 to June 2010) periods. Incidence is reported as infants with NAHT per month summarized over time periods. Continuous variables were compared using Mann-Whitney U-tests, and proportions were compared using the Fisher exact test.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Six hundred thirty-nine infant traumas were observed during the study time period. From the nonrecession to the recession period, there was an 8.2% reduction in all traumas (458 in 72 months [6.4 /month] vs 181 in 31 months [5.8/month]) and a 3.5% reduction in accidental head traumas (142 in 72 months [2.0/month] vs 59 in 31 months [1.9/month]). Nonaccidental head trauma accounted for 14.6% of all traumas (93/639). The median patient age was 4.0 months and 52% were boys. There were no significant differences in the representative counties of referral or demographics between nonrecession and recession populations (all p &gt; 0.05). The monthly incidence rates of NAHT doubled from nonrecession to recession periods (50 in 72 months [0.7/month] vs 43 in 31 months [1.4/month]; p = 0.01). During this recession, at least 1 NAHT was reported in 68% of the months compared with 44% of the months during the nonrecession period (p = 0.03). The severity of NAHTs also increased, with a greater proportion of deaths (11.6% vs 4%, respectively; p = 0.16) and severe brain injury (Glasgow Coma Scale score ≤ 8: 19.5% vs 4%, respectively; p = 0.06) during the recession.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In the context of an overall reduction in head trauma, the significant increase in the incidence of NAHT appears coincident with economic recession. Although the cause is likely multifactorial, a full analysis of the basis of this increase is beyond the scope of this study. This study highlights the need to protect vulnerable infants during challenging economic times.</jats:p></jats:sec>

National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm

“…[9][10][11] However, our study did not find a statistically significant increase in the rate of AHT nationally, regionally, or There are limitations to the current study. First, although the KID data set includes a large sample of all hospital discharges, it does not include the whole universe of pediatric discharges.…”

“…Three recent hospital-based studies [9][10][11] suggest that the number of cases of AHT in young children rose dramatically in parallel with the US recession of 2007 to 2009. None of these analyses examining AHT included complete state, regional, or national population-level data.…”

Association of Pediatric Abusive Head Trauma Rates With Macroeconomic Indicators

“…Another study demonstrated an increase in the number and severity of AHT cases during the recession compared with the period before the recession. 19 Finally, a study using a national sample of emergency department data reported that rates of AHT in children 4 years old or younger were higher during 2007 and 2008 compared with 2006 and 2009, suggesting an increase in AHT during the recession. 20 A recent systematic review of pediatric studies evaluating the impact of the great recession on health behaviors, child physical abuse, mental health, and health-related quality of life concluded that "the evidence to date demonstrates the plausibility of the association between the crisis and violence against children."…”

Community Poverty and Child Abuse Fatalities in the United States

“…28,32 Although the individual poverty of a child's family has been recognized as a risk factor for abuse 4,34,35 and for hospitalization from abuse, 7, 10 the relationship of community poverty on fatal child abuse is less well understood. 14,36,37 Local studies have noted increased rates of child abuse in impoverished communities. 28, 38, 39 In this study, we analyzed the association between community poverty and fatal child abuse at the national level and demonstrated a consistent association between community poverty concentration and child abuse fatalities across the study period.…”