Costs of Childhood Physical Abuse: Comparing Inflicted and Unintentional Traumatic Brain Injuries
* Department of Emergency Medicine, University of Colorado Health Sciences Center and Children’s Hospital, Denver, Colorado
Department of Economics, Brigham Young University, Provo, Utah
Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado
Objectives. To estimate the effect of early childhood abuse (ie, inflicted injury) on medical costs of head trauma.
Methods. Abstracts of patient records were drawn from the annual 1993–2000 Colorado state-mandated hospital discharge database maintained by the Colorado Hospital Association. The 2 dependent variables were total charges (TC) and length of stay. Our key independent variable was the nature of injury, ie, inflicted or unintentional; other independent variables were age, severity level, death, and trauma designation of the hospital. Comparisons of variables between patients with inflicted and unintentional head trauma were performed using Student’s t tests or 
2 statistics. Ordinary least squares regression was used to estimate the marginal and total effects of inflicted injury on TC and LOS.
Results. Of the 1097 head trauma patients <3 years old, 814 had unintentional and 283 had inflicted head trauma. Head trauma was defined using the Centers for Disease Control definition of traumatic brain injury. Patients with inflicted injuries were younger and had a higher average severity level and overall mortality rate than did patients with unintentional head trauma. The regression models showed that, controlling for age and severity, patients with inflicted head trauma stayed in the hospital 52% longer (2 days), and had a mean total bill 89% higher ($4232 more) than did patients with unintentional head trauma.
Conclusions. The findings from multivariate models of TC and length of stay corroborate the simpler univariate findings of earlier studies. By focusing on the impact of those cases of child abuse that lead to a specific, severe clinical entity (traumatic brain injury), we isolated a significant economic impact of abuse on health care expenditures for injury.
Key Words: child abuse • craniocerebral trauma • traumatic brain injury • direct service costs • health care costs • health expenditures • head injuries • hospital costs • length of stay • severity of illness • trauma • nervous system
Abbreviations: APR-DRG, All Patient-Refined Diagnosis-Related Groups • CC, complications and comorbidities • CHA, Colorado Hospital Association • EM, expectation maximization • ICD-9, International Classification of Diseases Coding Manual, Volume 9 • LOS, length of stay • PICU, pediatric intensive care unit • TBI, traumatic brain injury • TC, total charges
Received for publication Jul 1, 2002; Accepted Nov 12, 2002.
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