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Epidemiology and resource utilization in pediatric facial fractures
Tahereh Soleimani1, Shawn Travis Greathouse1, Rajiv Sood1
1Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Pediatric facial fractures treated at teaching hospitals did not show significant differences in length of stay or charges compared to non-teaching hospitals. This indicates teaching hospitals often manage more complex cases and underserved populations.
Area of Science:
- Trauma Surgery
- Pediatric Healthcare
- Health Services Research
Background:
- Pediatric facial fractures, often caused by violence, significantly impact public health and the economy.
- Teaching hospitals may have different resource utilization patterns compared to non-teaching facilities.
- Understanding disparities in care for pediatric facial fractures is crucial.
Purpose of the Study:
- To compare patient characteristics and outcomes for violence-related pediatric facial fractures between teaching and non-teaching hospitals.
- To identify factors influencing treatment and recovery in pediatric facial trauma.
- To evaluate the role of hospital type in managing pediatric facial fractures.
Main Methods:
- Analysis of the 2000-2009 Kids' Inpatient Database.
- Inclusion of 3881 pediatric patients (<18 years) with facial fractures due to assault, fight, or abuse.
- Comparison of demographics, injury patterns, and outcomes between teaching and non-teaching hospital admissions.
Main Results:
- 76.2% of pediatric facial fracture patients were treated at teaching hospitals.
- Patients at teaching hospitals were more likely to be younger, non-white, Medicaid recipients, from lower income areas, and have thoracic injuries.
- No significant difference in mortality rates was observed between hospital types.
Conclusions:
- Hospital teaching status did not predict longer lengths of stay (LOS) or charges after adjusting for confounders.
- Observed longer LOS at teaching hospitals is attributed to treating underserved populations and more severe injuries.
- Resource utilization for pediatric facial fractures shows nuanced differences based on patient demographics and injury severity, not solely hospital type.
Background:
Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures.
Methods:
Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes.
Results:
Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges.
Conclusions:
There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries.
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