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Published on: January 20, 2023
Costs of childhood physical abuse: comparing inflicted and unintentional traumatic brain injuries
Anne M Libby1, Marion R Sills, Norman K Thurston
1Department of Emergency Medicine, University of Colorado Health Sciences Center and Children's Hospital, Denver, Colorado 80045, USA. anne.libby@uchsc.edu
Insights
Child abuse causing head trauma significantly increases medical costs. Inflicted injuries result in longer hospital stays and higher total bills compared to unintentional head trauma.
Area of Science:
- Pediatrics
- Public Health
- Health Economics
Background:
- Early childhood abuse, specifically inflicted injury, is a critical public health concern.
- Head trauma in young children necessitates comprehensive medical evaluation and intervention.
- Understanding the economic burden of child abuse is crucial for resource allocation.
Purpose of the Study:
- To quantify the impact of early childhood abuse (inflicted injury) on the medical costs associated with head trauma.
- To compare healthcare expenditures for inflicted versus unintentional head trauma in young children.
Main Methods:
- Utilized a state-mandated hospital discharge database (1993-2000) from Colorado.
- Analyzed patient records for head trauma cases in children under 3 years old.
- Employed ordinary least squares regression to assess the effects of inflicted injury on total charges and length of stay, controlling for age and severity.
Main Results:
- Inflicted head trauma occurred in 283 of 1097 analyzed cases.
- Patients with inflicted injuries were younger, had higher severity, and greater mortality.
- Inflicted head trauma led to a 52% longer hospital stay and 89% higher total medical charges.
Conclusions:
- Early childhood abuse resulting in traumatic brain injury has a substantial economic impact on healthcare.
- The study confirms earlier findings on the increased healthcare costs associated with inflicted injuries.
- Addressing child abuse is essential for mitigating significant healthcare expenditures related to severe injuries.
Objectives:
To estimate the effect of early childhood abuse (ie, inflicted injury) on medical costs of head trauma.
Methods:
Abstracts of patient records were drawn from the annual 1993-2000 Colorado state-mandated hospital discharge database maintained by the Colorado Hospital Association. The 2 dependent variables were total charges (TC) and length of stay. Our key independent variable was the nature of injury, ie, inflicted or unintentional; other independent variables were age, severity level, death, and trauma designation of the hospital. Comparisons of variables between patients with inflicted and unintentional head trauma were performed using Student's t tests or chi2 statistics. Ordinary least squares regression was used to estimate the marginal and total effects of inflicted injury on TC and LOS.
Results:
Of the 1097 head trauma patients <3 years old, 814 had unintentional and 283 had inflicted head trauma. Head trauma was defined using the Centers for Disease Control definition of traumatic brain injury. Patients with inflicted injuries were younger and had a higher average severity level and overall mortality rate than did patients with unintentional head trauma. The regression models showed that, controlling for age and severity, patients with inflicted head trauma stayed in the hospital 52% longer (2 days), and had a mean total bill 89% higher (4232 dollars more) than did patients with unintentional head trauma.
Conclusions:
The findings from multivariate models of TC and length of stay corroborate the simpler univariate findings of earlier studies. By focusing on the impact of those cases of child abuse that lead to a specific, severe clinical entity (traumatic brain injury), we isolated a significant economic impact of abuse on health care expenditures for injury.
