title: Children injured by violence in the United States: emergency department utilization, 2000-2008.
abstract: OBJECTIVE
  Children victimized by violence are often treated in the emergency department (ED). However, our understanding of the magnitude and financial costs of this patient population is inadequate. The authors examined the scope, risk factors for, and financial cost of ED visits for intentional injury in children in the United States over time.
  
  
  METHODS
  Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2000 through 2008, the records of children aged 0 to 17 years evaluated in an ED for intentional injuries were examined. Nationally representative rates of ED visits for intentional injuries, the proportion of ED visits accounted for by children with intentional injuries, and risk factors for intentional injury visits were calculated. The Web-based Injury Statistics Query and Reporting System (WISQARS) Cost of Injury Reports was used to generate the medical costs accrued by intentional injuries in children.
  
  
  RESULTS
  Almost 340,000 children were treated in U.S. EDs each year from 2000 through 2008 for intentional injuries, comprising 1.2% (95% confidence interval [CI] = 1.1% to 1.4%) of all U.S. pediatric ED visits. The rate of ED visits for violent injuries has not changed over time. In 2008, 49 children per 10,000 (95% CI = 36 to 61) were treated in the ED for a violent injury. In a multivariate model, increasing age, residing in a metropolitan area, African American race, and the lack of private insurance were independent predictors of intentional injury visits among children. In 2005, the aggregate medical cost of intentionally inflicted injuries in children in the United States was $765 million.
  
  
  CONCLUSIONS
  ED visits among children for violent injury still represent an important clinical, public health, and economic challenge. The ED could be considered as a potential venue for prevention and intervention efforts.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital, Boston, Massachusetts, USA. michael.monuteaux@childrens.harvard.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Lois
authors.initials: L
authors.lastname: Lee
authors.forename: Eric
authors.initials: E
authors.lastname: Fleegler
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000191:economics* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000191:economics* / Q000706:statistics & numerical data*