title: Relationship between Insurance Type and Discharge Disposition From the Emergency Department of Young Children Diagnosed with Physical Abuse.
abstract: To describe the disposition of young children diagnosed with physical abuse in the emergency department (ED) setting and identify factors associated with the decision to discharge young abused children.
  
  
  
  We performed a retrospective cross-sectional study of children less than 2 years of age diagnosed with physical abuse in the 2006-2012 Nationwide Emergency Department Sample. National estimates were calculated accounting for the complex survey design. We developed a multivariable logistic regression model to evaluate the relationship between payer type and discharge from the ED compared with admission with adjustment for patient and hospital factors.
  
  
  
  Of the 37 655 ED encounters with a diagnosis of physical abuse among children less than 2 years of age, 51.8% resulted in discharge, 41.2% in admission, 4.3% in transfer, 0.3% in death in the ED, and 2.5% in other. After adjustment for age, sex, injury type, and hospital characteristics (trauma designation, volume of young children, and hospital region), there were differences in discharge decisions by payer and injury severity. The adjusted percentage discharged of publicly insured children with minor/moderate injury severity was 56.2% (95% CI 51.6, 60.7). The adjusted percentages discharged were higher for both privately insured children at 69.9% (95% CI 64.4, 75.5) and self-pay children at 72.9% (95% CI 67.4, 78.4). The adjusted percentages discharged among severely injured children did not differ significantly by payer.
  
  
  
  The majority of ED visits for young children diagnosed with abuse resulted in discharge. The notable differences in disposition by payer warrant further investigation.
authors.affiliation: Center for Pediatric Clinical Effectiveness; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: henrym2@email.chop.edu.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Henry
authors.affiliation: Center for Pediatric Clinical Effectiveness; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; PolicyLab.
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Wood
authors.affiliation: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Metzger
authors.affiliation: Health Coverage for Low-Income and Uninsured Populations, RTI International, Washington, DC.
authors.forename: Konny H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Center for Pediatric Clinical Effectiveness; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
mesh_terms: D002649:Child Abuse / Q000175:diagnosis; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000145:classification; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies
keywords: child abuse; emergency medicine; health care disparities