Huang Mary I, O'Riordan Mary Ann, Fitzenrider Ellen, McDavid Lolita, Cohen Alan R, Robinson Shenandoah
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.
J Neurosurg Pediatr. 2011 Aug;8(2):171-6. doi: 10.3171/2011.5.PEDS1139.
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.
非意外性头部创伤（NAHT）是婴儿死亡的主要原因。在当前的经济衰退期间，作者注意到非意外性头部创伤婴儿数量有所增加，但创伤性损伤入院婴儿总数并未增加。进行了一项分析以确定经济衰退与非意外性头部创伤之间是否存在关联。
经机构审查委员会批准，在创伤数据库中搜索2001年12月至2007年11月（非衰退期）和2007年12月至2010年6月（衰退期）期间0至2岁婴儿的非意外性头部创伤情况。发病率以每个时间段内每月非意外性头部创伤婴儿数量进行汇总报告。连续变量采用曼 - 惠特尼U检验进行比较，比例采用费舍尔精确检验进行比较。
在研究时间段内共观察到639例婴儿创伤。从非衰退期到衰退期，所有创伤减少了8.2%（72个月内458例[每月6.4例]对比31个月内181例[每月5.8例]），意外性头部创伤减少了3.5%（72个月内142例[每月2.0例]对比31个月内59例[每月1.9例]）。非意外性头部创伤占所有创伤的14.6%（93/639）。患者中位年龄为4.0个月，52%为男孩。非衰退期和衰退期人群在转诊代表县或人口统计学方面无显著差异（所有p>0.05）。非意外性头部创伤的月发病率从非衰退期到衰退期增加了一倍（72个月内50例[每月0.7例]对比31个月内43例[每月1.4例]；p = 0.01）。在此次衰退期间，68%的月份报告至少有1例非意外性头部创伤，而非衰退期为44%（p = 0.03）。非意外性头部创伤的严重程度也有所增加，衰退期死亡比例更高（分别为11.6%和4%；p = 0.16），严重脑损伤比例也更高（格拉斯哥昏迷量表评分≤8：分别为19.5%和4%；p = 0.06）。
在头部创伤总体减少的背景下，非意外性头部创伤发病率显著增加似乎与经济衰退同时发生。尽管原因可能是多因素的，但对这种增加的基础进行全面分析超出了本研究范围。本研究强调在经济困难时期保护脆弱婴儿的必要性。
