Increased incidence of nonaccidental head trauma in infants associated with the economic recession Clinical article
Increased incidence of nonaccidental head trauma in infants associated with the economic recession Clinical article
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DOI：
10.3171/2011.5.peds1139
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发表时间：
2011-08-01
影响因子：
1.9
通讯作者：
Robinson, Shenandoah
中科院分区：
文献类型：
--
作者：
Huang, Mary I.;O'Riordan, Mary Ann;Robinson, Shenandoah
Object.非意外头部创伤（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NAHT婴儿的轶事增加，而创伤性损伤婴儿的总数没有增加。进行分析，以确定是否有经济衰退和NAHT之间的关联。经机构审查委员会批准，在创伤数据库中检索了非衰退期（2001年12月至2007年11月）和衰退期（2007年12月至2010年6月）0-2岁婴儿的NAHT。发生率报告为不同时间段内每月NAHT的婴儿。使用Mann-Whitney U检验比较连续变量，使用Fisher精确检验比较比例。在研究期间观察到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[6.4 /月] vs 31个月内181例[5.8/月]），意外头部创伤减少了3.5%（72个月内142例[2.0/月] vs 31个月内59例[1.9/月]）。非意外性颅脑损伤占14.6%（93/639）。患者年龄中位数为4.0个月，52%为男孩。在转诊的代表县和人口统计学上，非经济衰退人群和经济衰退人群之间的差异均无统计学意义（均P > 0.05）。NAHT的月发病率从非衰退期到衰退期翻了一番（72个月50例[0.7/月] vs 31个月43例[1.4/月]; p = 0.01）。在这次经济衰退期间，68%的月份报告了至少1次NAHT，而非经济衰退期间的月份为44%（p = 0.03）。NAHT的严重程度也增加了，死亡比例（分别为11.6%和4%; p = 0.16）和严重脑损伤（格拉斯哥昏迷量表评分
Object. 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