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Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization
Yuerong Liu1, Megan Shepherd-Banigan2, Kelly E Evans1
1Center for Child and Family Policy, Duke University, Durham, NC, United States of America; Sanford School of Public Policy, Duke University, Durham, NC, United States of America.
Insights
Children evaluated for maltreatment have higher risks of emergency department visits and hospitalizations. This highlights the need for targeted support for families after a child maltreatment evaluation.
Area of Science:
- Pediatric Health
- Child Maltreatment Research
- Healthcare Utilization Studies
Background:
- Child maltreatment has severe health consequences, yet acute healthcare use post-evaluation is understudied.
- Understanding healthcare patterns after maltreatment evaluations is crucial for intervention.
Purpose of the Study:
- To determine the association between child maltreatment evaluations and subsequent acute healthcare use.
- To analyze emergency department (ED) visits and hospitalizations in young children after a maltreatment evaluation.
Main Methods:
- Retrospective cohort study comparing 367 children with maltreatment evaluations to 21,231 general pediatric patients.
- Analysis of acute healthcare utilization over 18 months using electronic health records.
- Survival analyses for time to ED visit/hospitalization, maltreatment-related visits, and ambulatory care sensitive conditions (ACSCs).
Main Results:
- Children with maltreatment evaluations showed increased hazard for ED visits/hospitalizations (HR: 1.3) and maltreatment-related visits (HR: 4.4).
- No significant association was found between maltreatment evaluations and healthcare use for ACSCs (HR: 1.0).
Conclusions:
- Child maltreatment evaluations are linked to increased acute healthcare utilization.
- Findings can guide anticipatory guidance for high-risk families to prevent harm and manage complications.
Background:
Child maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic.
Objective:
To quantify the association of having a child maltreatment evaluation with subsequent acute health care utilization among children from birth to age three.
Participants And Setting:
Children who received a maltreatment evaluation (N = 367) at a child abuse and neglect subspecialty clinic in an academic health system in the United States and the general pediatric population (N = 21,231).
Methods:
We conducted a retrospective cohort study that compared acute health care utilization over 18 months between the two samples using data from electronic health records. Outcomes were time to first emergency department (ED) visit or inpatient hospitalization, maltreatment-related ED use or inpatient hospitalization, and ED use or inpatient hospitalization for ambulatory care sensitive conditions (ACSCs). Multilevel survival analyses were performed.
Results:
Children who received a maltreatment evaluation had an increased hazard for a subsequent ED visit or inpatient hospitalization (hazard ratio [HR]: 1.3, 95 % confidence interval [CI]: 1.1, 1.5) and a maltreatment-related visit (HR: 4.4, 95 % CI: 2.3, 8.2) relative to the general pediatric population. A maltreatment evaluation was not associated with a higher hazard of health care use for ACSCs (HR: 1.0, 95 % CI: 0.7, 1.3).
Conclusion:
This work can inform targeted anticipatory guidance to aid high-risk families in preventing future harm or minimizing complications from previous maltreatment.
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