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Outcome and cost of child abuse
J E Irazuzta1, J E McJunkin, K Danadian
1Robert C. Byrd Health Sciences Center of West Virginia University/Charleston Division and Women & Children's Hospital, USA.
Insights
Child abuse (CA) in a pediatric intensive care unit (PICU) leads to significantly higher healthcare costs and mortality rates compared to other conditions. Prevention efforts are crucial given the poor outcomes and substantial financial burden of treating severe CA.
Area of Science:
- Pediatric critical care medicine
- Public health
- Medical economics
Background:
- Child abuse (CA) is a serious concern within pediatric healthcare settings.
- Understanding the economic and clinical impact of CA in a pediatric intensive care unit (PICU) is vital.
Purpose of the Study:
- To compare child abuse (CA) admissions with other pediatric intensive care unit (PICU) cases.
- To analyze differences in patient-specific healthcare costs, severity of illness (SI), and mortality.
- To describe the outcomes for child abuse patients.
Main Methods:
- Retrospective cohort study of PICU admissions from January 1991 to August 1994.
- Data collected included discharge diagnosis, age, severity of illness (SI), mortality rate, length of stay, and hospitalization charges.
- Comparison between child abuse cases and other patient groups.
Main Results:
- Child abuse (CA) accounted for 1.4% of admissions but 17% of deaths.
- CA patients exhibited the highest severity of illness (SI), hospitalization charges, and mortality rates (53%).
- Even after adjusting for SI, CA patients incurred higher daily hospitalization charges, with an average acute care cost of $35,641 per case; 70% died, and 60% of survivors had severe morbidity.
Conclusions:
- Interventional medical care for severe child abuse (CA) is extremely costly.
- Outcomes for CA patients are significantly worse than for other diseases.
- Resource allocation towards prevention of child abuse is imperative.
Objective:
To compare the cases of child abuse (CA) with other admissions in a pediatric intensive care unit (PICU) for differences in patient-specific health care costs, severity of illness (SI) and mortality, and describe their outcome.
Method:
A retrospective cohort study of all patients admitted to the PICU between January 1991 and August 1994. Discharge diagnosis, age, SI, mortality rate, length of stay, hospitalization charges ($Hosp), and mortality were retrieved.
Results:
There were 937 admissions; 13 were secondary to CA. Cases of CA represented 1.4% of admissions and 17% of deaths. CA patients had the highest SI (61%), $Hosp ($30,684), daily charges ($5,294) and mortality rates (53%) than any other group. In our patients, SI is a factor that affects charges. Even when compared to a cohort group with SI, child abuse patients had higher daily hospitalization charges (p < .05). The medical bills for the acute care of a CA patient averaged $35,641 per case. Even with these expenditures, 70% died and 60% of the survivors had severe residual morbidity.
Conclusion:
These results confirm that interventional medical care in response to severe CA is very costly and the ultimate outcome is significantly worse than other diseases. Therefore, we believe it is imperative to allocate resources to prevention.