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Non-accidental head injury: a consequence of deprivation?
  1. J Y Q Mok1,
  2. P A Jones2,
  3. E Myerscough3,
  4. A R F Shah4,
  5. R A Minns1
  1. 1The Royal Hospital for Sick Children, Edinburgh, and Section of Child Life and Health, University of Edinburgh, Edinburgh, UK
  2. 2Section of Child Life and Health, University of Edinburgh, Edinburgh, UK
  3. 3Royal Aberdeen Children's Hospital, Aberdeen, UK
  4. 4University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Robert A Minns, Child Life and Health, University of Edinburgh, 20 Sylvan Place, Edinburgh EH9 1UW, UK; robert.minns{at}ed.ac.uk

Abstract

Background Non-accidental head injury (NAHI) is a significant personal and public health problem, with considerable mortality and morbidity. The evidence base for risk factors specific for NAHI is limited due to difficulties with case definition and study design. The risk factors associated with NAHI in infants was evaluated in this study, and the extent to which indices of deprivation influence this health problem was addressed.

Methods A 10-year prospective study was conducted in Scotland involving all paediatric hospitals and other general hospital departments admitting children. Subjects were children ≤2 years of age, with a diagnosis of “suspected NAHI”. Socioeconomic characteristics of the index cases were compared to the general population, using the Scottish Index of Multiple Deprivation (SIMD) 2006.

Results There were highly significant differences (p<0.001) between the SIMD rank scores of the NAHI cases and scores for the whole Scottish population. For the cohort, SIMD ranks ranged from 34 to 6253 (median 1210; mean 1577) compared to the population range of 1–6505 (median and mean=3253). Similar differences were found for each of the component domains of income, employment, health, education, crime and housing (p<0.001). In contrast, the scores for “geographic access” (to essential service) were higher than for the whole population (p<0.001), indicating that the deprivation was not due to lack of local services.

Conclusion In Scotland, children who present with suspected NAHI originate predominantly from the most deprived areas of the community. Public health and intervention strategies should be focused in these areas.

  • Non-accidental head injury
  • inflicted brain injury
  • risk factors
  • deprivation indices
  • childhood injury
  • risk prediction
  • social paediatrics
  • violence RB

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Footnotes

  • Funding Lloyds TSB Foundation for Scotland, Riverside House, 502 Gorgie Road, Edinburgh EH11 3AF, UK.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Multi-Centre Research Ethics Committee, Deaconess House 148, Pleasance, Edinburgh EH8 9RS, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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