title: Increased incidence of inflicted traumatic brain injury in children after a natural disaster.
abstract: BACKGROUND
  The incidence of child abuse following natural disasters has not been studied thoroughly. However, parental stress and decreased social support have been linked to increased reports of child maltreatment. We hypothesized that a large-scale natural disaster (North Carolina's Hurricane Floyd) would increase the incidence of inflicted traumatic brain injury (TBI) in young children.
  
  
  METHODS
  An ecologic study design was used to compare regions affected to those regions unaffected by the disaster. Cases of inflicted TBI resulting in admission to an intensive care unit or death from September 1998 through December 2001 in North Carolina were ascertained. Poisson regression modeling was employed to calculate rate ratios of injury for each geographic area by time period.
  
  
  RESULTS
  Inflicted TBI in the most affected counties increased in the 6 months post-disaster in comparison to the same region pre-disaster (rate ratio 5.1, 95% confidence interval [CI]=1.3-20.4), as did non-inflicted TBI (rate ratio 10.7, 95% CI=2.0-59.4). No corresponding increased incidence was observed in counties less affected or unaffected by the disaster. The rate of inflicted injuries returned to baseline in the severely affected counties 6 months post-hurricane; however, the rate of non-inflicted injuries appeared to remain elevated for the entire post-hurricane study period.
  
  
  CONCLUSIONS
  Families are vulnerable to an elevated risk of inflicted and non-inflicted child TBI following a disaster. This information may be useful in future disaster planning.
authors.affiliation: Department of Social Medicine, University of North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7240, USA. hkeenan@med.unc.edu
authors.forename: Heather T
authors.initials: HT
authors.lastname: Keenan
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.forename: Mary Alice
authors.initials: MA
authors.lastname: Nocera
authors.forename: Desmond K
authors.initials: DK
authors.lastname: Runyan
mesh_terms: D017677:Age Distribution; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D004190:Disasters; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010287:Parent-Child Relations; D016012:Poisson Distribution; D011336:Probability; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate