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Cost of Pediatric Trauma: A Comparison of Non-Accidental and Accidental Trauma in Pediatric Patients

Published:December 02, 2022DOI:https://doi.org/10.1016/j.jss.2022.08.045

      Abstract

      Background

      Nonaccidental trauma (NAT) affects >100,000 children in the United States every year and is associated with significant mortality and morbidity. Little is known about the financial burden of NAT, particularly in comparison to accidental trauma (AT). We sought to compare hospital charges and outcomes between children presenting with NAT and AT.

      Methods

      Pediatric (<16 y) trauma hospitalizations from 2006 to 2018 were identified using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and Kid’s Inpatient Sample (KID) databases. Hospitalizations were identified as NAT or AT based on ICD codes. Discharge weights were used to obtain national estimates and standardize them across the different sampling structures. Outcomes (hospital charges, length of stay (LOS), and mortality) were compared, and multivariate regression analyses were used to assess independent predictors of hospital charges and mortality.

      Results

      Fifty-eight Thousand Two Hundred Seventy-five pediatric hospitalizations were included with 17,954 (0.3%) categorized as NAT. Children with NAT were younger, more female, less likely to identify as White, and more under public insurance than those with AT. Hospital charges were significantly higher in patients with NAT ($27,100 versus $19,900, P < 0.0001). Mortality (4.9% versus 0.0%, P < 0.0001) and LOS (3.2 d versus 1.5 d, P < 0.0001) were significantly higher among patients with NAT. Multivariable regression analyses identified NAT as a predictor of higher hospital charges, mortality, and LOS.

      Conclusions

      Nonaccidental trauma in pediatric patients is associated with significantly higher hospital charges, mortality, and LOS than accidental trauma. Ongoing research focused on the relative impact of known risk factors and resource utilization is needed.

      Keywords

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      References

        • Borse N.
        • Sleet D.A.
        CDC childhood injury report: patterns of unintentional injuries among 0- to 19-year olds in the United States, 2000-2006.
        Fam Community Health. 2009; 32: 189
      1. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2021).
        Child Maltreat. 2019; (Available at:)
        • Swedo E.
        • Idaikkadar N.
        • Leemis R.
        • et al.
        Trends in U.S. Emergency department visits related to suspected or confirmed child abuse and neglect among children and adolescents aged <18 years before and during the COVID-19 pandemic - United States, January 2019-September 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1841-1847
        • Zonfrillo M.R.
        • Spicer R.S.
        • Lawrence B.A.
        • Miller T.R.
        Incidence and costs of injuries to children and adults in the United States.
        Inj Epidemiol. 2018; 5: 37
        • Naik-Mathuria B.
        • Akinkuotu A.
        • Wesson D.
        Role of the surgeon in non-accidental trauma.
        Pediatr Surg Int. 2015; 31: 605-610
        • Livingston J.K.
        • Grigorian A.
        • Kuza C.M.
        • et al.
        Non-accidental trauma increases length of stay and mortality in pediatric trauma.
        Pediatr Surg Int. 2019; 35: 779-784
        • Shahi N.
        • Phillips R.
        • Meier M.
        • et al.
        The true cost of child abuse at a level 1 pediatric trauma center.
        J Pediatr Surg. 2020; 55: 335-340
        • Estroff J.M.
        • Foglia R.P.
        • Fuchs J.R.
        A comparison of accidental and nonaccidental trauma: it is worse than you think.
        J Emerg Med. 2015; 48: 274-279
        • DiScala C.
        • Sege R.
        • Li G.
        • Reece R.M.
        Child abuse and unintentional injuries: a 10-year retrospective.
        Arch Pediatr Adolesc Med. 2000; 154: 16-22
        • Ettaro L.
        • Berger R.P.
        • Songer T.
        Abusive head trauma in young children: characteristics and medical charges in a hospitalized population.
        Child Abuse Negl. 2004; 28: 1099-1111
        • Miller T.R.
        • Steinbeigle R.
        • Lawrence B.A.
        • et al.
        Lifetime cost of abusive head trauma at ages 0-4, USA.
        Prev Sci. 2018; 19: 695-704
        • Peterson C.
        • Xu L.
        • Florence C.
        • et al.
        The medical cost of abusive head trauma in the United States.
        Pediatrics. 2014; 134: 91-99
        • Letourneau E.J.
        • Brown D.S.
        • Fang X.
        • Hassan A.
        • Mercy J.A.
        The economic burden of child sexual abuse in the United States.
        Child Abuse Negl. 2018; 79: 413-422
        • Lane W.G.
        • Lotwin I.
        • Dubowitz H.
        • Langenberg P.
        • Dischinger P.
        Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma.
        Pediatrics. 2011; 127: e1400-e1405
        • Nunez Lopez O.
        • Hughes B.D.
        • Adhikari D.
        • Williams K.
        • Radhakrishnan R.S.
        • Bowen-Jallow K.A.
        Sociodemographic determinants of non-accidental traumatic injuries in children.
        Am J Surg. 2018; 215: 1037-1041
      2. Health care cost and utilization Project (HCUP).
        (Available at:)
        https://www.ahrq.gov/data/hcup/index.html
        Date accessed: November 25, 2022
      3. Healthcare cost and utilization Project (HCUP). KID overview.
        (Available at:)
        https://www.hcup-us.ahrq.gov/kidoverview.jsp
        Date accessed: February 9, 2021
      4. Centers for Disease Control and Prevention. Child Abuse and Neglect: Risk and Protective Factors. Available at: https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html. Accessed February 9, 2021.

        • Jones R.E.
        • Babb J.
        • Gee K.M.
        • Beres A.L.
        An investigation of social determinants of health and outcomes in pediatric nonaccidental trauma.
        Pediatr Surg Int. 2019; 35: 869-877
        • Litz C.N.
        • Amankwah E.K.
        • Danielson P.D.
        • Chandler N.M.
        Implications of non-accidental trauma on resource utilization and outcomes.
        Pediatr Surg Int. 2018; 34: 635-639
        • Curry S.J.
        • Krist A.H.
        • Owens D.K.
        • et al.
        • U. S. Preventive Services Task Force
        Interventions to prevent child maltreatment: US preventive services Task Force recommendation statement.
        JAMA. 2018; 320: 2122-2128