title: Increased incidence of nonaccidental head trauma in infants associated with the economic recession.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 > 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Neurological Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. maryihuang@gmail.com
authors.forename: Mary I
authors.initials: MI
authors.lastname: Huang
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Riordan
authors.forename: Ellen
authors.initials: E
authors.lastname: Fitzenrider
authors.forename: Lolita
authors.initials: L
authors.lastname: McDavid
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
authors.forename: Shenandoah
authors.initials: S
authors.lastname: Robinson
mesh_terms: D002649:Child Abuse / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000191:economics / Q000453:epidemiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D057172:Economic Recession / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009820:Ohio / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014478:Unemployment / Q000706:statistics & numerical data