Citation

Deutsch SA, Zomorrodi A, Zent J, Kirk A, O'Brien P, Loiselle C, DeJong A. Acad. Pediatr. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2022.03.017

PMID

35367403

Abstract

OBJECTIVE: Performance of occult injury screening including skeletal surveys and neuroimaging is recommended to comprehensively evaluate suspected child physical abuse. Screening performance-associated hospital costs and net revenue for care of index abuse victims and siblings/household contacts is largely unknown. We aimed to describe 1) costs and net revenue associated with radiologic occult injury screening at an urban level 1 pediatric trauma center, 2) areas of perceived high resource intensity (time spent in abuse victim-related care), and 3) detection yield among children undergoing occult injury screening and physical assessment.

METHODS: Using time-driven activity-based cost analysis, hospital, per physician, staff, and radiology costs associated with occult injury screening performance were mapped for 199 children < 2 years old. Hospital costs and resource times were approximated and compared with net revenue for each healthcare encounter. Abstracted variables included index/sibling status, injury classification, length of stay (LOS).

RESULTS: Of 199 children with variable LOS (0-45 days), total hospital costs (facility, physician, staff, radiology) ranged $297.83-$81,474; net revenue was positive. Total ED time per abuse case varied 32-1823 minutes; social work (SW) time ranged 44-720 minutes; prolonged ED/SW time represented resource-intense areas. Of siblings, 27% were diagnosed with unanticipated findings based on occult injury screening and examination.

CONCLUSIONS: At a single center, occult injury screening was associated with cost variability, resource intensity, and enhanced victim identification when external examination findings or clinical symptoms were absent. While further study is needed, cost and resource concerns associated with screening may be offset by societal benefit and minimal hospital-based financial losses.

Language: en

Keywords

injury prevention; child abuse; screening; cost analysis