Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2020 Nov/Dec;40(10):e932-e935. doi: 10.1097/BPO.0000000000001577.
Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with ∼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures.
We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital's billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed.
Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs.
The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference.
Level III-retrospective review.
骨折是仅次于软组织损伤的儿童虐待第二常见表现，约 60%的骨折为股骨、肱骨或胫骨骨折。虽然研究表明，非意外伤害（NAT）相关的医疗费用增加，但与意外伤害（AT）相关骨折相比，NAT 相关骨折的成本数据很少。本研究旨在考虑与 NAT 相关的股骨骨折与 AT 相关的股骨骨折的经济负担。
我们对 2007 年至 2016 年在一级儿科创伤中心接受石膏固定治疗的 1 岁以下儿童进行了回顾性研究。变量包括年龄、性别、住院时间和从该医院计费部门获得的估计总计费成本。此外，评估了骨折部位（中段、远端、近端和转子下）和模式。
共分析了 60 名平均年龄为 7 个月的儿童。在出院前，19 例（31.7%）怀疑为 NAT，9 例（15%）确诊。分析了两组：NAT 组包括可疑和确诊的虐待病例（28 例）和 AT 组包括其余 32 例。这两组之间的人口统计学特征没有显著差异。NAT 组的住院时间长于 AT 组（78.9 与 36.7 h，P<0.001）。NAT 组的整体消费者价格指数调整后的住院费用比 AT 组高 24726 美元（P=0.024），实验室检查、放射学和非骨科医师费用是导致费用增加的前 3 大因素。
1 岁以下儿童股骨骨折中，NAT 的总体发生率为 46.6%。NAT 组治疗骨折的总住院费用比 AT 组高 1.5 倍，影像学费用是造成费用差异的最主要因素。
三级-回顾性研究。
