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

Clinical article

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  • 1 Division of Pediatric Neurological Surgery,
  • 2 Department of Pediatrics, and
  • 3 Pediatric Trauma Center, University Hospitals Rainbow Babies and Children's Hospital, Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
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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.

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Contributor Notes

Address correspondence to: Mary I. Huang, M.D., M.S., University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106. email:
  • 1

    Dashti SR, , Decker DD, , Razzaq A, & Cohen AR: Current patterns of inflicted head injury in children. Pediatr Neurosurg 31:302306, 1999

  • 2

    Duhaime AC, , Christian CW, , Rorke LB, & Zimmerman RA: Nonaccidental head injury in infants—the “shaken-baby syndrome. N Engl J Med 338:18221829, 1998

    • Search Google Scholar
    • Export Citation
  • 3

    Graupman P, & Winston KR: Nonaccidental head trauma as a cause of childhood death. J Neurosurg 104:4 Suppl 245250, 2006

  • 4

    Johnson N, , Oliff P, & Williams E: An Update on State Budget Cuts: At Least 46 States Have Imposed Cuts That Hurt Vulnerable Residents and the Economy Center on Budget and Policy Priorities ( [Accessed May 17, 2011]

    • Search Google Scholar
    • Export Citation
  • 5

    Minns RA, , Jones PA, & Mok JY: Incidence and demography of non-accidental head injury in southeast Scotland from a national database. Am J Prev Med 34:4 Suppl S126S133, 2008

    • Search Google Scholar
    • Export Citation
  • 6

    Mok JY, , Jones PA, , Myerscough E, , Shah AR, & Minns RA: Nonaccidental head injury: a consequence of deprivation?. J Epidemiol Community Health 64:10491055, 2010

    • Search Google Scholar
    • Export Citation
  • 7

    National Bureau of Economic Research: US Business Cycle Expansions and Contractions ( [Accessed May 17, 2011]

    • Search Google Scholar
    • Export Citation
  • 8

    Stoodley N: Non-accidental head injury in children: gathering the evidence. Lancet 360:271272, 2002

  • 9

    Tucker IB: Survey of Economics ed 6 Mason, OH, Cengage Learning, 2008. 243

  • 10

    Tung GA, , Kumar M, , Richardson RC, , Jenny C, & Brown WD: Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626633, 2006

    • Search Google Scholar
    • Export Citation


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