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

Clinical article

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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.


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.


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.


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.

Abbreviations used in this paper: GCS = Glasgow Coma Scale; NAHT = nonaccidental head trauma.

Article Information

Address correspondence to: Mary I. Huang, M.D., M.S., University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Distribution of patients younger than 2 years of age admitted to Rainbow Babies & Children's Hospital from December 2001 through June 2010.

  • View in gallery

    Bar graph showing that from the nonrecession to the recession time period, a 1-fold increase occurred in infants younger than 2 years of age with NAHT within the context of an overall mild reduction in the number of infants with any trauma or accidental head trauma. *p = 0.01 (Mann-Whitney U-test).

  • View in gallery

    Graph of unemployment rates (monthly, weighted by county) and NAHT rates (quarterly). The vertical line divides the recent recession from the earlier nonrecession period. Based on 2010 data from the Bureau of Labor Statistics (


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