Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance.
BACKGROUND
Limited data are available regarding differences in presentation and management of pediatric emergency department (PED) patients based on insurance status. The objective of the study was to assess the difference in management of pediatric facial lacerations based on medical insurance status.


METHODS
We conducted a retrospective cohort study with universal sampling of patients with facial lacerations who were treated in an urban PED (45K visits/year) over a one-year period. Demographic features and injury characteristics for patients with commercial (private) insurance and those with Medicaid or Medicare (public) insurance were compared.


RESULTS
Of 1235 children included in the study, 667 (54%) had private insurance and 485 (39%) had public insurance. The two groups did not differ in age or gender, arrival by ambulance, location of injury occurrence, mechanism of injury, part of face involved, length or depth of laceration, use of local anesthetic, or method of repair but differed in acuity assigned at triage. Patients with public insurance were found less likely to have subspecialty consultation in bivariable (OR=0.41, 95% CI [0.24-0.68]) and multivariable logistic regression analyses (OR=0.45, 95% CI [0.25-0.78]). Patients with public insurance received procedural sedation significantly less often than those with private insurance (OR=0.48, 95% CI [0.29-0.76]). This difference was not substantiated in multivariable models (OR=0.74, 95% CI [0.40-1.31]).


CONCLUSIONS
Patients with public insurance received less subspecialty consultation compared to privately insured patients despite a similarity in the presentation and characteristics of their facial lacerations. The reasons for these disparities require further investigation.
Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island ; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island.
Siraj
S
Amanullah
Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island ; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island.
James G
JG
Linakis
Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island ; School of Public Health at Brown University, Providence, Rhode Island.
Patrick M
PM
Vivier
Harvard Medical School, Department of Plastic Surgery, Cambridge, Massachusetts.
Emily
E
Clarke-Pearson
Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island ; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island.
Dale W
DW
Steele
D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital; D005151:Facial Injuries / Q000191:economics*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000145:classification*; D007348:Insurance, Health / Q000145:classification*; D022125:Lacerations / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States