Abusive head trauma in young children: characteristics and medical charges in a hospitalized population

• Published in: Child abuse & neglect 2004-10, Vol.28 (10), p.1099-1111
• Main Authors: Ettaro, Lorraine, Berger, Rachel P., Songer, Thomas
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Charges; Child; Child Abuse; Child abuse & neglect; Child Abuse - classification; Child Abuse - statistics & numerical data; Child, Preschool; Comparative study; Craniocerebral trauma; Craniocerebral Trauma - classification; Craniocerebral Trauma - etiology; Economic Impact; Fees & charges; Female; Head Injuries; Hospital charges; Hospitalization; Hospitalization - economics; Hospitals; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Infants; Injury Severity Score; Length of Stay; Male; Medical Records; Medical sciences; Nosology. Terminology. Diagnostic criteria; Pennsylvania - epidemiology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Techniques and methods; Trauma; Treatment; USA; Victimology; Young Children
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2004.06.006

To describe the presenting characteristics, hospital course, and hospital charges associated with hospital admissions for head trauma in young children at a regional pediatric trauma center, and to examine whether these factors differ among abused and non-abused subjects. Comparative case series study involving a retrospective medical record review of children less than 3 years of age admitted to Children's Hospital of Pittsburgh from January 1, 1995 to December 31, 1999. Subjects ( n = 377) were identified on the basis of ICD-9-CM codes for head injury. Subjects were classified as abused or non-abused based on standard criteria using information about the type of injuries, the history provided by the caretaker, and physical and radiographic findings. Eighty nine (23.6%) subjects were classified as abused and 288 (76.4%) were classified as non-abused. Abused subjects were more likely then non-abused subjects to be 1 year of age) (OR: 9.8; 95% CI: 5.0, 19.2), covered by Medicaid (vs. commercial insurance) (OR: 2.8; 95% CI: 1.7, 4.8), and admitted to the ICU (OR: 3.5; 95% CI: 2.1, 5.8; p < .001). The caretakers of abused subjects were more likely to give a history of no trauma or minor trauma compared to the caretakers of non-abused subjects (97% vs. 54%, p < .001). Length of stay was significantly greater for abused subjects versus non-abused subjects (mean: 9.25 days vs. 3.03 days, p < .001). Hospital charges (1999 dollars) were significantly higher for abused (mean ± SD: $40,082 ± $58,004) versus non-abused (mean ± SD: $15,671 ± $41,777) subjects. These results highlight the differences in the demographics, presenting characteristics and economic impact of abusive head injuries compared to non-abusive head injuries. Décrire (1) les caractéristiques observées chez des enfants admis pour cause de traumatismes à la tête dans un centre hospitalier régional de traumatismes pédiatriques (2) le déroulement de l’hospitalisation et (3) les frais hospitaliers par rapport à ces admissions, puis d’examiner si ces facteurs varient selon que ces traumatismes furent le résultat de mauvais traitements ou non. Une étude comparative d’une série de cas, par le biais d’une revue rétrospective des dossiers médicaux d’enfants de moins de trois ans admis à l’hôpital pédiatrique de Pittsburgh entre le 1 er janvier 1995 et le 31 décembre 1999. En se servant de la nomenclature ICD-9-CM pour traumatismes crâniens, on a retenu 377 dossiers qu’on a classés “maltr