title: Surgical Treatment of Pediatric Craniofacial Fractures: A National Perspective.
abstract: BACKGROUND
  Head trauma is the most common cause of death because of injury in children, and trauma alone is the leading cause of morbidity and mortality in pediatrics. This study aimed to characterize the demographics and economic burden associated with the surgical and nonsurgical repair of craniofacial fractures in the pediatric inpatient population in the United States.
  
  
  METHODS
  A retrospective cohort study was performed using the 2012 Kids' Inpatient Database which identified 20,070 patients who had a skull or facial fracture, of whom 6395 (31.9%) were treated surgically. Epidemiologic patient and hospital data were analyzed as potential determinants of surgical treatment, prolonged hospitalizations, and higher charges.
  
  
  RESULTS
  Pediatric craniofacial fractures are estimated to represent $1.2 billion of national healthcare expenditures annually. The average patient charge for surgical treatment of a craniofacial fracture in the pediatric population is $84,849 compared with $52,490 for nonsurgical management (P < 0.001), and the average length of stay was longer for surgical repair when compared with nonsurgical management for craniofacial fractures (5.3 days versus 4.6 days, P < 0.001). Patients who were older, African American, had nonprivate insurance, whose fracture was caused by external trauma, and who were treated in an urban hospital had an independently increased likelihood of surgical repair of craniofacial fractures. Patients who were older, female, insured, of lower income brackets, whose fracture was caused by a motor vehicle accident, who had surgical treatment of their craniofacial fracture, and who were treated in hospitals in the South, Midwest, or West, teaching hospitals, and government-owned hospitals had an independent risk for a prolonged hospitalization. Patients who were older, Caucasian, insured, whose fracture was caused by a motor vehicle accident, and who were treated in hospitals in the South, teaching hospitals, pediatric hospitals, larger hospitals, and government-owned hospitals had an independent risk for increased patient charges.
  
  
  CONCLUSIONS
  Craniofacial fractures in the pediatric population represent a large economic burden to the patient and family, as well as the healthcare system as a whole. The identified patient and hospital demographics that are associated with prolonged hospital stays and higher patient charges may represent potential barriers to care, and additional research to elucidate these factors is warranted.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Massenburg
authors.forename: Paymon
authors.initials: P
authors.lastname: Sanati-Mehrizy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D015984:Causality; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008446:Maxillofacial Injuries / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012887:Skull Fractures / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States