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

  • Stephanie Anne Deutsch
    Correspondence
    Address correspondence to Stephanie Anne Deutsch, MD, MS, Nemours Children's Health, 1801 Rockland Rd, Wilmington, DE 19803
    Affiliations
    Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del

    Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
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  • Arezoo Zomorrodi
    Affiliations
    Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del

    Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
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  • James Zent
    Affiliations
    Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
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  • Alexander Kirk
    Affiliations
    Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
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  • Paul O'Brien
    Affiliations
    Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
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  • Claire Loiselle
    Affiliations
    Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del

    Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
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  • Allan De Jong
    Affiliations
    Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del

    Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
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Published:March 30, 2022DOI:https://doi.org/10.1016/j.acap.2022.03.017

      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 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.

      Keywords

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