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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Article Info
Publication History
Published online: March 30, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: Drs. Deutsch and DeJong provide expert witness testimony and consultancy for suspected child abuse and neglect cases. Other authors have nothing to disclose.
Identification
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Copyright © 2022 by Academic Pediatric Association
