Child Maltreatment Related Injuries: Incidence, Hospital Charges, and Correlates of Hospitalization
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1 Child Maltreatment Related Injuries: Incidence, Hospital Charges, and Correlates of Hospitalization Samuel N. Forjuoh, MB, ChB, DrPH Department of Family Medicine Scott & White Memorial Hospital and Clinic Texas A&M University, Temple, Texas
2 Background Child Maltreatment (CM): Comprise child abuse & child neglect Associated with profound health effects Physical injuries & disabilities Mental & behavioral problems Lack of epidemiology of CM-related injuries resulting in hospitalization: Albeit injury is one of the hallmarks
3 Purpose Determine the incidence, hospital charges, correlates,, and outcomes associated with inpatient treatment of child maltreatment (CM)
4 Significance Enhance health care personnel s reporting habits of CM, particularly those resulting from injury Mandatory reporting agencies to CPS: 16% rate by Education personnel 13% rate by Law Enforcement personnel 12% rate by Social Services personnel 11% rate by Health Care personnel
5 Methods Retrospective 1-year, population- based study using 1995 PA HDD Computation of per capita rates Denominator: : 1995 estimated pop. of PA Cut-off point: : 5 discharges Determination of correlates of admission via Logistic Regression Modeling
6 Participants Case identification (persons 0-19 yr.) E codes: external cause-of-injury codes Codes denoting procedures, observations, or medical diagnoses associated w/ CM Comparison group (persons 0-19 yr.) A 5% random sample not related to CM
7 Incidence Rates Overall rate = 10.8 per 1,000 N N = 348 maltreated children 0-19 yr. 12.5% of all assaultive & self- inflicted injuries Highest among < 1 yr. (67.8 per 1,000) & blacks (23.2 per 1,000)
8 Hospital Charges Total hospital charges = $5.4 m Medicaid alone paid for 45% Mean = $5776; Median = $15,587 Mean and median charges were not significantly different from those of non CM related injury discharges
9 Demo. Characteristics - I Characteristic Disch. for Injury from Maltreatment (n=348) Disch. for Injury from Other Cause (n=1052) p Age of Child < 1 year 1-4 years 5-9 years years years 102 (29) 91 (26) 29 (8) 54 (16) 72 (21) 48 (5) 161 (15) 170 (16) 248 (24) 425 (40) P<.0001 Race of Child White Black Other 207 (60) 92 (26) 48 (14) 712 (68) 183 (18) 152 (14) P<.005
10 Demo. Characteristics - II Characteristic Disch. for Injury from Maltreatment (n=348) Disch. for Injury from Other Cause (n=1052) p Gender of Child Male Female Hispanic Origin Yes No Resid. Location Urban Mixed Rural 177 (51) 171 (49) 16 (5) 332 (95) 175 (50) 127 (13) 45 (37) 668 (64) 384 (36) 36 (3) 1015 (97) 525 (51) 324 (17) 175 (32) P<.0001 P=.33 P<.09
11 Adm. Characteristics - I Characteristic Disch. for Injury from Maltreatment (n=348) Disch. For Injury from Other Cause (n=1052) p Adm. Source E.R. M.D. Refer Transfer Other Refer 197 (57) 79 (23) 61 (17) 11 (3) 707 (67) 198 (19) 41 (4) 106 (10) P<.0001 Type of Adm. Emergency Urgent Elective 241 (69) 86 (25) 20 (6) 775 (72) 186 (18) 106 (10) P<.005
12 Adm. Characteristics - II Characteristic Expected Payer Self-pay Medicaid B.C./Comm Other Hosp. L.O.S. <= 1 day 2-3 days 4-7 days 8-14 days > 14 days Disch. for Injury from Maltreatment (n=348) 9 (3) 163 (47) 125 (36) 51 (15) 68 (20) 82 (24) 96 (28) 44 (13) 58 (17) Disch. for Injury from Other Cause (n=1052) 46 (4) 232 (22) 583 (56) 191 (18) 468 (45) 309 (29) 158 (15) 59 (6) 58 (5) p P<.0001 P<.0001
13 Injury Characteristics - I Characteristic Mechanism Poisoning Cut/Piercing Fall Struck by Other Intent Unintentional Self-inflicted Assault Other/Undet Disch. for Injury from Maltreatment (n=348) 61 (20) 19 (6) 9 (3) 6 (2) 207 (69) 49 (16) 66 (22) 181 (60) 6 (2) Disch. For Injury from Other Cause (n=1052) 156 (16) 44 (5) 204 (21) 88 (9) 461 (49) 769 (81) 111 (12) 57 (6) 16 (2) p P<.05 P<.0001
14 Injury Characteristics - II Characteristic Disch. for Injury from Maltreatment (n=348) Disch. For Injury from Other Cause (n=1052) p Severity Minor Moderate Serious Severe/Crit. 71 (40) 61 (34) 17 (10) 30 (17) 205 (28) 359 (49) 131 (18) 38 (5) P<.0001 Assoc. Mental Condition Yes No 104 (31) 244 (69) 30 (3) 1022 (97) P<.0001
15 Disp. Characteristics Characteristic Disch. for Injury from Maltreatment (n=348) Disch. For Injury from Other Cause (n=1052) p Discharge Disp Routine home 298 (86) 919 (87) P<.05 Disch to O/F 40 (11) 125 (12) Died 10 (3) 8 (1)
16 Correlates of Admission - I Characteristic Crude OR (95% C.I.) Adjusted OR (95% C.I) Age of Child < 5 years 5-19 years Race of Child Black Other White Adm. Source E.R. Referrral Transfer 5.0 ( ) * ( ) * 0.9 ( ) ( ) * 1.2 ( ) ( ) ** ( ) 0.7 ( ) ( ) ** 0.6 ( ) 1.0
17 Correlates of Admission - II Characteristic Crude OR (95% C.I.) Adjusted OR (95% C.I) Expected Payer Medicaid Other Severity of Injury Serious/Crit Minor/Mod 3.1 ( ) * ( ) ( ) ** ( ) 1.0 Type of Adm. Intent of Injury Associated M/C Excluded from Multivariate Logistic Modeling Due to Multi-colinearity Issues
18 Discussion Results corroborate those of others: NCCAN, young children, females 2NIPSCAN, corr.. w/ young children Irazuzta et al, high cost to treat CM APAM, x in-hospital mortality However, present study demo:
19 Conclusions Injury from CM: A A major cause of hospitalization A A significant cost to publicly financed health care in the U.S. Children injured from CM unique: Demographic characteristics Admission, injury, & outcome
20 Footnote A Manuscript based on presentation is in press with Child Abuse & Neglect
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