Costs of childhood physical abuse: comparing inflicted and unintentional traumatic brain injuries.
OBJECTIVE
To estimate the effect of early childhood abuse (ie, inflicted injury) on medical costs of head trauma.


METHODS
Abstracts of patient records were drawn from the annual 1993-2000 Colorado state-mandated hospital discharge database maintained by the Colorado Hospital Association. The 2 dependent variables were total charges (TC) and length of stay. Our key independent variable was the nature of injury, ie, inflicted or unintentional; other independent variables were age, severity level, death, and trauma designation of the hospital. Comparisons of variables between patients with inflicted and unintentional head trauma were performed using Student's t tests or chi2 statistics. Ordinary least squares regression was used to estimate the marginal and total effects of inflicted injury on TC and LOS.


RESULTS
Of the 1097 head trauma patients <3 years old, 814 had unintentional and 283 had inflicted head trauma. Head trauma was defined using the Centers for Disease Control definition of traumatic brain injury. Patients with inflicted injuries were younger and had a higher average severity level and overall mortality rate than did patients with unintentional head trauma. The regression models showed that, controlling for age and severity, patients with inflicted head trauma stayed in the hospital 52% longer (2 days), and had a mean total bill 89% higher (4232 dollars more) than did patients with unintentional head trauma.


CONCLUSIONS
The findings from multivariate models of TC and length of stay corroborate the simpler univariate findings of earlier studies. By focusing on the impact of those cases of child abuse that lead to a specific, severe clinical entity (traumatic brain injury), we isolated a significant economic impact of abuse on health care expenditures for injury.
Libby
Anne M
AM
Department of Emergency Medicine, University of Colorado Health Sciences Center and Children's Hospital, Denver, Colorado 80045, USA. anne.libby@uchsc.edu
Sills
Marion R
MR
Thurston
Norman K
NK
Orton
Heather D
HD
D000059:Accidents / Q000191:economics / Q000706:statistics & numerical data; D001925:Brain Damage, Chronic / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D001930:Brain Injuries / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D002649:Child Abuse / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D004180:Direct Service Costs; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D015599:Trauma Severity Indices; D014836:Volition