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Childhood Victims of Violence: Hospital Utilization by Children With Intentional Injuries

Childhood Victims of Violence: Hospital Utilization by Children With Intentional Injuries Abstract Objective: To describe the utilization of hospital resources by children admitted with intentional injuries. Methods: A sample of medical records for patients 14 years old and younger admitted to a pediatric tertiary care teaching hospital with a level I pediatric trauma center between January 1, 1991, and December 31, 1992, with intentional injuries (external cause codes E950 to E969) and unintentional injuries (E800 to E949) were reviewed after identification from the trauma center and hospital discharge registries. Results: Of 1495 patients admitted for injuries, 95 had intentional injuries. Among these, 36% were caused by child abuse, 37% were caused by assaults, and the remainder were associated with suicide attempts. Compared with all unintentionally injured patients, those with intentional injuries were similar in gender and race but were significantly older (P<.001). Compared with a randomly selected sample of unintentionally injured patients matched for age, gender, and race, intentionally injured patients had longer mean hospital stays (P<.001), had more medical consultations (P<.001), were more likely to be discharged to sites other than home (P<.001), and had higher hospital charges (P=.007). While intentionally injured children had higher Injury Severity Scores (P=.002), their longer hospital stays were independent of injury severity. Conclusions: Intentionally injured children use more hospital resources and consequently incur higher hospital charges than those with unintentional injuries. Injury acuity contributes to this phenomenon, as do complex social needs. These data suggest that efforts directed at preventing intentional injuries will significantly affect injury-related health care costs.(Arch Pediatr Adolesc Med. 1996;150:415-420) References 1. National Center for Health Statistics. Advance report of final mortality statistics, 1991 . Monthly Vital Stat Rep . 1993;42( (suppl) ):1-61. 2. Division of Injury Control, Centers for Disease Control. Childhood injuries in the United States . AJDC . 1990;144:627-646. 3. Guyer B, Ellers B. Childhood injuries in the United States: mortality, morbidity and cost . AJDC . 1990;144:649-652. 4. Malek M, Chang B-H, Gallagher SS, Guyer B. The cost of medical care for injuries to children . Ann Emerg Med . 1991;20:997-1005.Crossref 5. MacKenzie EJ, Morris JA, deLissovoy GV, Smith G, Fahey M. Acute hospital costs of pediatric trauma in the United States: how much and who pays? J Pediatr Surg . 1990;25:970-976.Crossref 6. Rachuba L, Stanton B, Howard D. Violent crime in the United States: an epidemiologic profile . Arch Pediatr Adolesc Med . 1995;149:953-960.Crossref 7. Centers for Disease Control and Prevention. Deaths resulting from firearm and motor vehicle related injuries—United States, 1968-1991 . MMWR Morb Mortal Wkly Rep . 1994:43:37-42. 8. International Classification of Diseases, Ninth Revision, Clinical Modification . 2nd ed. Washington, DC: Health Care Financing Administration; 1980; 1-3. 9. Baker SP, O'Neill B, Haddon W, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma . 1974;14:187-196.Crossref 10. Baker SP, O'Neill B, Ginsburg MJ, Li G. The Injury Fact Book . 2nd ed. New York, NY: Oxford University Press; 1992. 11. Long WB, Bachulis BL, Hynes GD. Accuracy and relationship of mechanism of injury, Trauma Score and Injury Severity Score in identifying major trauma . Am J Surg . 1986;151:581-585.Crossref 12. Rice DP, MacKenzie EJ, and associates. Cost of Injury in the United States: A Report to Congress . San Francisco, Calif: Institute for Health and Aging, University of California; and Baltimore, Md: Injury Prevention Center, Johns Hopkins University; 1989. 13. Miller TR, Cohen MA, Rossman SB. Victim costs of violent crime and resulting injuries . Health Affairs . 1993;12:186-197.Crossref 14. Litaker DG. Injuries in early adolescence: implications for prevention . Arch Pediatr Adolesc Med . 1994;148( (suppl) ):P98. 15. Williams BC, Kotch JB. Excess injury mortality among children in the United States: comparison of recent international statistics . Pediatrics . 1990;86( (suppl) ):1067-1073. 16. Luna GK, Kendall K, Pilcher S, Copass M, Herman C. The medical and social impact of nonaccidental injury . Arch Surg . 1988;123:825-827.Crossref 17. Robicsek F, Ribbeck B, Walker LG, Thomason MH, Hollenbeck JL, Baker JW. The cost of violence: the economy of health care delivery for non-accidental trauma in an urban southeastern community . N C Med J . 1993;54:578-582. 18. Peclet MH, Newman KD, Eichelberger MR, Gotsehall CS, Guzzetta PC. Patterns of injury in children . J Pediatr Surg . 1990;25:85-91.Crossref 19. Dolins JC, Christoffel KK. Reducing violent injuries: priorities for pediatrician advocacy . Pediatrics . 1994;94( (suppl) ):638-651. 20. Singer MI, Anglin TM, Song L, Lunghofer L. Adolescents' exposure to violence and associated symptoms of psychological trauma . JAMA . 1995;273:477-482.Crossref 21. Guyer B, Lescohier I, Gallagher SS, Hansman A, Azzara CV. Intentional injuries among children and adolescents in Massachusetts . N Engl J Med . 1989;321: 1584-1589.Crossref 22. Grossman DC, Rivara FP. Injury control in childhood . Pediatr Clin North Am . 1992;39:471-485. 23. Christoffel KK. Violent death and injury in US children and adolescents . AJDC . 1990;144:697-706. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Childhood Victims of Violence: Hospital Utilization by Children With Intentional Injuries

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References (25)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1996.02170290081013
Publisher site
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Abstract

Abstract Objective: To describe the utilization of hospital resources by children admitted with intentional injuries. Methods: A sample of medical records for patients 14 years old and younger admitted to a pediatric tertiary care teaching hospital with a level I pediatric trauma center between January 1, 1991, and December 31, 1992, with intentional injuries (external cause codes E950 to E969) and unintentional injuries (E800 to E949) were reviewed after identification from the trauma center and hospital discharge registries. Results: Of 1495 patients admitted for injuries, 95 had intentional injuries. Among these, 36% were caused by child abuse, 37% were caused by assaults, and the remainder were associated with suicide attempts. Compared with all unintentionally injured patients, those with intentional injuries were similar in gender and race but were significantly older (P<.001). Compared with a randomly selected sample of unintentionally injured patients matched for age, gender, and race, intentionally injured patients had longer mean hospital stays (P<.001), had more medical consultations (P<.001), were more likely to be discharged to sites other than home (P<.001), and had higher hospital charges (P=.007). While intentionally injured children had higher Injury Severity Scores (P=.002), their longer hospital stays were independent of injury severity. Conclusions: Intentionally injured children use more hospital resources and consequently incur higher hospital charges than those with unintentional injuries. Injury acuity contributes to this phenomenon, as do complex social needs. These data suggest that efforts directed at preventing intentional injuries will significantly affect injury-related health care costs.(Arch Pediatr Adolesc Med. 1996;150:415-420) References 1. National Center for Health Statistics. Advance report of final mortality statistics, 1991 . Monthly Vital Stat Rep . 1993;42( (suppl) ):1-61. 2. Division of Injury Control, Centers for Disease Control. Childhood injuries in the United States . AJDC . 1990;144:627-646. 3. Guyer B, Ellers B. Childhood injuries in the United States: mortality, morbidity and cost . AJDC . 1990;144:649-652. 4. Malek M, Chang B-H, Gallagher SS, Guyer B. The cost of medical care for injuries to children . Ann Emerg Med . 1991;20:997-1005.Crossref 5. MacKenzie EJ, Morris JA, deLissovoy GV, Smith G, Fahey M. Acute hospital costs of pediatric trauma in the United States: how much and who pays? J Pediatr Surg . 1990;25:970-976.Crossref 6. Rachuba L, Stanton B, Howard D. Violent crime in the United States: an epidemiologic profile . Arch Pediatr Adolesc Med . 1995;149:953-960.Crossref 7. Centers for Disease Control and Prevention. Deaths resulting from firearm and motor vehicle related injuries—United States, 1968-1991 . MMWR Morb Mortal Wkly Rep . 1994:43:37-42. 8. International Classification of Diseases, Ninth Revision, Clinical Modification . 2nd ed. Washington, DC: Health Care Financing Administration; 1980; 1-3. 9. Baker SP, O'Neill B, Haddon W, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma . 1974;14:187-196.Crossref 10. Baker SP, O'Neill B, Ginsburg MJ, Li G. The Injury Fact Book . 2nd ed. New York, NY: Oxford University Press; 1992. 11. Long WB, Bachulis BL, Hynes GD. Accuracy and relationship of mechanism of injury, Trauma Score and Injury Severity Score in identifying major trauma . Am J Surg . 1986;151:581-585.Crossref 12. Rice DP, MacKenzie EJ, and associates. Cost of Injury in the United States: A Report to Congress . San Francisco, Calif: Institute for Health and Aging, University of California; and Baltimore, Md: Injury Prevention Center, Johns Hopkins University; 1989. 13. Miller TR, Cohen MA, Rossman SB. Victim costs of violent crime and resulting injuries . Health Affairs . 1993;12:186-197.Crossref 14. Litaker DG. Injuries in early adolescence: implications for prevention . Arch Pediatr Adolesc Med . 1994;148( (suppl) ):P98. 15. Williams BC, Kotch JB. Excess injury mortality among children in the United States: comparison of recent international statistics . Pediatrics . 1990;86( (suppl) ):1067-1073. 16. Luna GK, Kendall K, Pilcher S, Copass M, Herman C. The medical and social impact of nonaccidental injury . Arch Surg . 1988;123:825-827.Crossref 17. Robicsek F, Ribbeck B, Walker LG, Thomason MH, Hollenbeck JL, Baker JW. The cost of violence: the economy of health care delivery for non-accidental trauma in an urban southeastern community . N C Med J . 1993;54:578-582. 18. Peclet MH, Newman KD, Eichelberger MR, Gotsehall CS, Guzzetta PC. Patterns of injury in children . J Pediatr Surg . 1990;25:85-91.Crossref 19. Dolins JC, Christoffel KK. Reducing violent injuries: priorities for pediatrician advocacy . Pediatrics . 1994;94( (suppl) ):638-651. 20. Singer MI, Anglin TM, Song L, Lunghofer L. Adolescents' exposure to violence and associated symptoms of psychological trauma . JAMA . 1995;273:477-482.Crossref 21. Guyer B, Lescohier I, Gallagher SS, Hansman A, Azzara CV. Intentional injuries among children and adolescents in Massachusetts . N Engl J Med . 1989;321: 1584-1589.Crossref 22. Grossman DC, Rivara FP. Injury control in childhood . Pediatr Clin North Am . 1992;39:471-485. 23. Christoffel KK. Violent death and injury in US children and adolescents . AJDC . 1990;144:697-706.

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Apr 1, 1996

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