A needle in a haystack: the use of routinely collected emergency department injury surveillance data to help identify physical child abuse

Hospital Costs, Revenue, and Abuse Detection Associated With Occult Injury Screening

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 are 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, and length of stay (LOS).

RESULTS

Of 199 children with variable LOS (0-45 days), total hospital costs (facility, physician, staff, radiology) ranged $297.83 to $81,474; net revenue was positive. Total ED time per abuse case varied 32 to 1823 minutes; social work (SW) time ranged 44 to 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.

Patterns of Injury in Hospitalised One-Year-Old Children: Analysis by Trimester of Age Using Coded Data and Textual Description

The second year of life is a time of rapid developmental changes. This paper aims to describe the pattern of unintentional injuries to one-year old children in three-month age bands to better understand the risks associated with developmental stages and, therefore, identify opportunities for proactive prevention. Injury surveillance data were used to identify children admitted to hospital in Queensland, Australia for an unintentional injury from 2002–2012. Falls were the most common injury, followed by burns and scalds, contact injuries and poisonings. Falls and contact injuries remained roughly constant by age, burns and scalds decreased and poisonings (by medications) increased. Animal- and transport-related injuries also became more common, immersions and other threats to breathing less common. Within the falls and contact categories falls from play equipment and injuries due to contact with persons increased, while falls down stairs and catching fingers in doors decreased. The pattern of injuries varies over the second year of life and is clearly linked to the child’s increasing mobility and boldness. Preventive measures for young children need to be designed—and evaluated—with their developmental stage in mind, using a variety of strategies, including opportunistic, developmentally specific education of parents; and practitioners should also consider potential for lapses in supervision and possible intentional injury in all injury assessments.