Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Rd., Tainan 70101, Taiwan.
Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Rd., Tainan 70101, Taiwan; Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd., Tainan 70403, Taiwan.
Child Abuse Negl. 2022 Jun;128:105603. doi: 10.1016/j.chiabu.2022.105603. Epub 2022 Mar 24.
Abusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited.
To estimate health services utilization and costs attributable to AHT among children aged 0-4 years in Taiwan.
Sixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator).
Health services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models.
AHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64-17.27 times, 1.25-5.22 times, and 1.77-2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors.
Children with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative.
虐待性头部外伤 (AHT) 是一种严重的健康问题，是受虐待儿童中死亡率最高的原因。许多 AHT 幸存者都有长期的后遗症，需要接受治疗。然而，在国家层面上，关于 AHT 相关的卫生服务利用和费用的知识是有限的。
估计台湾 0-4 岁儿童 AHT 相关的卫生服务利用和费用。
使用台湾国家人口数据库，在 2003 年至 2015 年间，确定了 63 例致命性和 664 例幸存者 AHT 病例。根据出生年份、性别、索引日期的历年、参保地点和医疗保险费（社会经济地位指标），共选择了 2656 名非 AHT 儿童，与幸存者病例进行了 4:1 的精确匹配。
根据索引日期，每年计算卫生服务的利用情况和费用。通过回归模型评估 3 年随访期间 AHT 相关的卫生服务利用和费用。
AHT 诊断与住院、住院时间、急诊室 (ER) 就诊和门诊就诊呈正相关。在 3 年期间，AHT 相关的医疗费用分别为住院、ER 和门诊的 1.64-17.27 倍、1.25-5.22 倍和 1.77-2.36 倍。与匹配对照相比，致命性 AHT 病例的住院利用率更高，医疗费用也更高。
AHT 患儿的卫生服务利用率更高，费用也更高。减少 AHT 对医疗体系负担的策略势在必行。
