Peterson Cora, Xu Likang, Florence Curtis, Parks Sharyn E, Miller Ted R, Barr Ronald G, Barr Marilyn, Steinbeigle Ryan
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia;
Pacific Institute for Research & Evaluation, Calverton, Maryland, and Centre for Population Health Research, Curtin University, Perth, Australia;
Pediatrics. 2014 Jul;134(1):91-9. doi: 10.1542/peds.2014-0117. Epub 2014 Jun 16.
Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT.
Using Truven Health MarketScan data, 2003-2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagnoses. We used exact case-control matching based on demographic and insurance characteristics such as age and health plan type to compare medical care between patients with and without AHT diagnoses. Using regression models, we assessed service use (ie, average annual number of inpatient visits per patient) and inpatient, outpatient (including emergency department), drug, and total medical costs attributable to an AHT diagnosis during the 4-year period after AHT diagnosis.
We assessed 1209 patients with AHT and 5895 matched controls. Approximately 48% of patients with AHT received inpatient care within 2 days of initial diagnosis, and 25% were treated in emergency departments. AHT diagnosis was associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after the diagnosis. The estimated total medical cost attributable to AHT in the 4 years after diagnosis was $47,952 (95% confidence interval [CI], $40,219-$55,685) per patient with AHT (2012 US dollars) and differed for commercially insured ($38,231 [95% CI, $29,898-$46,564]) and Medicaid ($56,691 [95% CI, $4290-$69,092]) patients.
Children continue to have substantial excess medical costs for years after AHT. These estimates exclude related nonmedical costs such as special education and disability that also are attributable to AHT.
摇晃婴儿综合征或儿科虐待性头部创伤（AHT）对健康的影响可能严重且持久。我们旨在估算AHT所致的多年医疗费用。
利用2003年至2011年Truven Health MarketScan数据，我们确定了年龄在0至4岁、拥有商业保险或医疗补助保险且被诊断为AHT的儿童。我们根据年龄和健康计划类型等人口统计学和保险特征进行精确病例对照匹配，以比较有和没有AHT诊断的患者之间的医疗护理情况。使用回归模型，我们评估了AHT诊断后4年内因AHT诊断导致的服务使用情况（即每位患者每年住院就诊的平均次数）以及住院、门诊（包括急诊科）、药品和总医疗费用。
我们评估了1209例AHT患者和5895例匹配对照。约48%的AHT患者在初次诊断后2天内接受了住院治疗，25%在急诊科接受治疗。AHT诊断与诊断后多年内显著更多的医疗服务使用以及更高的住院、门诊、药品和总费用相关。诊断后4年，AHT所致的估计总医疗费用为每位AHT患者47,952美元（95%置信区间[CI]，40,219美元至55,685美元）（2012年美元），商业保险患者（38,231美元[95%CI，29,898美元至46,564美元]）和医疗补助患者（56,691美元[95%CI，4290美元至69,092美元]）有所不同。
AHT后的数年里，儿童的医疗费用仍持续大幅超支。这些估计未包括相关的非医疗费用，如特殊教育和残疾费用，而这些费用也归因于AHT。
