A. E. Peace1, D. M. Caruso2, C. B. Agala2, M. R. Phillips1, S. E. McLean1, D. K. Nakayama1, A. A. Hayes-Jordan1, A. C. Akinkuotu1 1University Of North Carolina At Chapel Hill, Division Of Pediatric Surgery, Department Of Surgery, Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill, Department Of Surgery, Chapel Hill, NC, USA
Introduction: Non-accidental trauma (NAT) affects more than half a million children in the United States every year. NAT is associated with significant mortality and morbidity, however less is known about the financial burden, particularly in comparison to accidental trauma (AT), in the pediatric population. We sought to compare hospital length of stay and charges between pediatric patients presenting with NAT and AT.
Methods: Pediatric (<16 years) trauma hospitalizations from 2006-2018 were identified using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and Kid’s Inpatient Sample (KID) databases. Hospitalizations were identified as NAT or AT based on ICD codes. Discharge weights were used to obtain national estimates and standardize across the different sampling structures. Sampling strata include Census division, location (urban vs. rural), teaching status, hospital control, and bed size. Multivariate logistic and linear regression, adjusting for demographics and hospital characteristics, were used to assess association between NAT and AT admissions and inpatient outcomes (length of stay, total charges and death).
Results: A total of 582,880 pediatric patient hospitalizations were included with 18,302 (3.3%) of those categorized as NAT. Table 1 illustrates the comparison of demographics and outcomes between patient groups. NAT patients were younger at admission, more female, less likely to be categorized as white (47.2% vs. 53.5%; p<0.001), more under public insurance, and more from low-income households (41.5% vs. 31.3%; p<0.001) than AT patients. There was significantly higher mortality, hospital length of stay, and hospital charges among NAT patients compared to those with AT. On multivariate regression analysis, patients with NAT were more than three times as likely to die as those with AT (aOR: 3.4; 95%CI: 3.1-3.9). NAT was associated with significantly longer hospital length of stay (CIE: 2.6; 95%CI: 1.6-3.6) and higher hospital charges (CIE: 11.6 95%CI 7.9-15.3) compared to AT.
Conclusion: Using an administrative, national database, we found that non-accidental trauma in pediatric patients is associated with significantly higher hospital charges, longer hospital length of stay and mortality rate than accidental trauma. This study, one of the largest of its kind, highlights the need for ongoing community injury prevention efforts and parental/caregiver education to decrease the incidence of non-accidental trauma.
