Hospital Costs and Charges of Discharge Delays in Children Hospitalized for Abuse and Neglect

Lee, Michael; Bachim, Angela; Smith, Caroline J.; Camp, Elizabeth A.; Donaruma‐Kwoh, Marcella; Patel, Binita

doi:10.1542/hpeds.2017-0027

Cited by 12 publications

(11 citation statements)

References 9 publications

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“…Other studies have documented longer lengths of stay for children hospitalized with abusive injuries (Russo et al, 2008). A study conducted in a large children’s hospital in Texas found that 1 in 5 abused children experienced a delay of discharge after medical clearance by greater than 1 day, many related to child welfare placement (Lee et al, 2017). In addition to longer lengths of stay, the decision to admit a child for hospitalization may also be influenced by the complex social disposition of patients with suspected abusive injuries in order to ensure a safe and appropriate placement where the child is not at risk for further abuse.…”

Section: Discussionmentioning

confidence: 99%

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

et al. 2020

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Hospitalization data provide context to understanding abusive and non-abusive injuries and how these hospitalizations change over time. The purpose of this study was to utilize Texas inpatient hospitalization data to assess age-related differences among infants (<12 months of age) and toddlers (12–59 months of age) in injury trends and patterns of injury among abusive and non-abusive hospitalization encounters over a 15-year time period. For both age groups, pediatric hospitalizations for non-abusive injuries decreased significantly over time; however, hospitalizations for abusive injuries did not. Compared to non-abusive injury hospitalizations, abusive injury hospitalizations were statistically more likely to involve more body regions and were associated with fractures, internal organ injuries, and superficial wounds. Abusive injury hospitalizations had longer lengths of stay and resulted in higher illness severity scores. Toddler injury hospitalizations were associated with most of the body regions, with the exception of traumatic brain injury for which the odds of hospitalization were higher for infants. This study confirms the persistence of abusive injury hospitalizations and the age-related susceptibility to certain injuries comparing infants and toddlers. The findings reflect the clinical documentation and decision making of pediatric practitioners in a large state over 15 years and inform the trends in identification of injuries which are most common and consistent by age and intent.

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Section: Discussionmentioning

confidence: 99%

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

et al. 2020

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“…En-Pei Lee et al retrospectively reviewed cases of child maltreatment admitted to Chang Gung Memorial Hospital at Linkou from 2001 to 2015 and observed that the abusive trauma group had longer stays in the ICU than the neglectful trauma group (18.2±23.9 days vs 7.2±6.9 days respectively, p<0.01), and often a worse prognosis [13]. Children who were diagnosed as abused or neglected were more likely to die during hospitalization, have longer hospital stays, and have greater medical expenses [14][15][16][17][18]. These were compatible with our outcome analysis which neglected patients tended to have significantly better outcome and shorter ICU stay.…”

Section: Discussionmentioning

confidence: 99%

“…These were compatible with our outcome analysis which neglected patients tended to have significantly better outcome and shorter ICU stay. Furthermore, some discharges were delayed despite medical clearance due to a lack of safe deposition [17]. Referral to multidisciplinary child protective service organizations significantly reduces the avoidable days of hospitalization and health care waste [19].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2020

AJPN

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Child maltreatment has long been a worldwide problem and can be life-threatening to children. Since the nineteen sixties, relevant authorities in the U.S. have been raising awareness on the issue. Prior to that, children had been viewed as their parents' property, and no law punished the abusive behavior. In 1946, John Caffey published a report of six infants with subdural hematoma and long bone fractures and indicated a relationship between them and child abuse [1]. In 1962, a landmark year, Henry Kempe and his colleagues published the article, "The battered-child syndrome, [2]" which sparked interest in researching child abuse and brought the subject to national attention [3]. The World Health Organization (WHO) defined child maltreatment, sometimes referred to as child abuse and neglect, as any form of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development, or dignity [4]. Abuse refers to caregivers that carry out acts of physical harm or sexual harassment toward children or acts that have adversely emotional effects on children's

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“…The process of child protective services obtaining legal custody and/or identifying a safety plan including a foster caregiver may extend beyond the time period required for resolution of medical issues. 17 Thus, once the foster caregiver is identified, discharge may occur relatively quickly, often without time for foster caregivers to actively participate in patient care in the hospital with the child. In some cases, the child protective services representative may accompany the child from the hospital to the foster caregiver, such that information Length of stay was included in final regressions for communication with PCP, follow-up call completed, misunderstandings at follow-up call, and readmissions.…”

Section: Discussionmentioning

confidence: 99%

Improving Hospital-to-Home Transitions for Children Entering Foster Care

DeLucia

Martens

Leyenaar

et al. 2018

Hospital Pediatrics

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Hospital-to-home transition quality measures were less often implemented for children discharged with new foster caregivers than for the cohort of patients discharged with preadmission caregivers. This may lead to increased morbidity, as suggested by more frequent caregiver misunderstandings. Better prospective identification of these patients and enhanced transition improvement efforts targeted at their new caregivers may be warranted.

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Hospital Costs and Charges of Discharge Delays in Children Hospitalized for Abuse and Neglect

Abstract: Continued hospitalization beyond medical clearance occurs often and represents a significant cost. Further study is needed to evaluate whether interventions can be targeted at children with characteristics correlated with prolonged discharge delays.

Cited by 12 publications

References 9 publications

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

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Improving Hospital-to-Home Transitions for Children Entering Foster Care

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