Childhood victims of violence. Hospital utilization by children with intentional injuries
M. S. Wright and D. Litaker
Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
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.
