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April 1996

Childhood Victims of Violence: Hospital Utilization by Children With Intentional Injuries

Author Affiliations

From the Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio (Dr Wright); and Department of General Internal Medicine, Cleveland Clinic Foundation (Dr Litaker).

Arch Pediatr Adolesc Med. 1996;150(4):415-420. doi:10.1001/archpedi.1996.02170290081013

Objective:  To describe the utilization of hospital resources by children admitted with intentional injuries.

Methods:  A sample of medical records for patients 14 years old and younger admitted to a pediatric tertiary care teaching hospital with a level I pediatric trauma center between January 1, 1991, and December 31, 1992, with intentional injuries (external cause codes E950 to E969) and unintentional injuries (E800 to E949) were reviewed after identification from the trauma center and hospital discharge registries.

Results:  Of 1495 patients admitted for injuries, 95 had intentional injuries. Among these, 36% were caused by child abuse, 37% were caused by assaults, and the remainder were associated with suicide attempts. Compared with all unintentionally injured patients, those with intentional injuries were similar in gender and race but were significantly older (P<.001). Compared with a randomly selected sample of unintentionally injured patients matched for age, gender, and race, intentionally injured patients had longer mean hospital stays (P<.001), had more medical consultations (P<.001), were more likely to be discharged to sites other than home (P<.001), and had higher hospital charges (P=.007). While intentionally injured children had higher Injury Severity Scores (P=.002), their longer hospital stays were independent of injury severity.

Conclusions:  Intentionally injured children use more hospital resources and consequently incur higher hospital charges than those with unintentional injuries. Injury acuity contributes to this phenomenon, as do complex social needs. These data suggest that efforts directed at preventing intentional injuries will significantly affect injury-related health care costs.(Arch Pediatr Adolesc Med. 1996;150:415-420)