Study Analyzes Non-Accidental Head Trauma in Infants and the Economic Recession/Child Abuse Connection
1-Apr-2011 9:00 AM EDT
Newswise — DENVER (April 13, 2011) − Tragically, infants experience severe or fatal head trauma as a result of intentional abuse. Shaken baby syndrome, now commonly referred to as non-accidental head trauma, is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying. Babies have very weak neck muscles that cannot fully support their proportionately large heads. Severe shaking causes the baby’s head to move violently back and forth, resulting in serious and sometimes fatal brain injury. These forces are exaggerated if the shaking is interrupted by the baby’s head hitting a surface.
An estimated 1,300 children in the US experience severe or fatal head trauma associated with child abuse every year. Non-fatal consequences of abusive head trauma include varying degrees of visual impairment, motor impairment, cognitive impairments, and in the worst cases, an irreversible vegetative state. “There have been other studies analyzing the relationship between economic hardship and child abuse, including head trauma, but this research focuses specifically on severe head trauma trends in infants, the most vulnerable population,” said Mary I. Huang, MS, lead author.
Researchers at University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine in Cleveland analyzed the correlation between non-accidental head trauma in infants and periods of economic recession. The results of this study, Rise in Non-Accidental Head Trauma Incidence and Severity in Infants Associated with Economic Recession, will be presented by Ms. Huang, 4:01-4:07 pm, Wednesday, April 13, during the 79th Annual Scientific Meeting of the American Association of Neurological Surgeons in Denver. Co-authors are MaryAnn O'Riordan, MS, Ellen Fitzenrider, BA, RHIT, Lolita McDavid, MD, and Shenandoah Robinson, MD. Ms. Huang will be presented with the Byron Cone Pevehouse MD Award for this research.
The authors examined the trauma database at their institution for non-accidental head trauma (NAHT) incidents incurred by infants under the age of 2 during a period of non-recession (December 2001-November 2007) and during a period of recession (December 2007-June 2010). Of 639 infants under the age of 2 admitted for traumatic injuries, 93 were NAHT cases. Additional patient demographics:
•Gender: 52 percent male, 48 percent female•Mean age: 4 months•Caucasian: 46.2 percent, African American: 40.9 percent•No statistical differences in gender, age, or race/ethnicity were found between the 50 infants evaluated for NAHT during the non-recession period and the 43 infants evaluated for NAHT during the recession period.
Incidence is reported as the number of NAHTs per month summarized over time periods using Mann-Whitney test analysis. Fisher exact tests were utilized to compare the proportion of months with NAHTs, and severity of NAHTs, assessed by admission Glasgow Coma Scale (GCS) and deaths. The analysis yielded the following statistics:
•NAHT incidence doubled from non-recession to recession periods: 50 cases/72 months versus 43 cases/31 months (p=0.01).
•This phenomenon occurred in the context of a mild decline in the monthly rate of any traumatic injury or accidental head injury for children < 2 years old from the non-recession period compared to the recent recession period.
•The proportion of months in which at least one infant was admitted for NAHT was greater during the recession period than during the non-recession period (p=0.03), 68 percent versus 44 percent, respectively.
•There was a trend for infants admitted for evaluation of NAHT during the recession period to have more severe head injuries, as measured by the admission GCS, than those admitted during the non-recession period (p=0.06). Similarly, more infants died from their injuries during the initial hospitalization during the recession period (11.6 percent), compared to the non-recession period (4.0 percent, p=0.16). Neither trend was statistically significant.
“Financial stresses such as unemployment, foreclosure, and difficulties finding adequate childcare are likely exacerbated during a recession. We found an increase in the number of infants who were evaluated for abusive head trauma at our institution during the recent recession, compared to the prior non-recession period. The complex social issues that led to this trauma are beyond the scope of our research, but certainly warrant further study,” said Ms. Huang.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.
Disclosure: the author reports no conflicts of interest.
Media Representatives: If you would like to cover the meeting or interview a neurosurgeon − either on-site or via telephone − please contact the AANS Communications Department at (847) 378-0517 or call the Annual Meeting Press Room beginning Monday, April 11 at (303) 228-8431.