Relationship between Insurance Type and Discharge Disposition From the Emergency Department of Young Children Diagnosed with Physical Abuse

• Published in: The Journal of pediatrics Vol. 177; pp. 302 - 307.e1
• Main Authors: Henry, M. Katherine, MD, MSCE, Wood, Joanne N., MD, MSHP, Metzger, Kristina B., PhD, MPH, Kim, Konny H., MPH, Feudtner, Chris, MD, PhD, MPH, Zonfrillo, Mark R., MD, MSCE
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: child abuse; Child Abuse - diagnosis; Cross-Sectional Studies; emergency medicine; Emergency Service, Hospital; Female; health care disparities; Humans; Infant; Insurance, Health - classification; Male; Patient Discharge; Pediatrics; Retrospective Studies; SES; NEDS; Socioeconomic status; child abuse; emergency medicine; International Classification of Diseases, Ninth Revision, Clinical Modification; ISS; health care disparities; Abbreviated Injury Scale; AIS; Injury Severity Score; Emergency department; ICD-9-CM; Nationwide Emergency Department Sample; ED
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.06.021

Objectives To describe the disposition of young children diagnosed with physical abuse in the emergency department (ED) setting and identify factors associated with the decision to discharge young abused children. Study design We performed a retrospective cross-sectional study of children less than 2 years of age diagnosed with physical abuse in the 2006-2012 Nationwide Emergency Department Sample. National estimates were calculated accounting for the complex survey design. We developed a multivariable logistic regression model to evaluate the relationship between payer type and discharge from the ED compared with admission with adjustment for patient and hospital factors. Results Of the 37 655 ED encounters with a diagnosis of physical abuse among children less than 2 years of age, 51.8% resulted in discharge, 41.2% in admission, 4.3% in transfer, 0.3% in death in the ED, and 2.5% in other. After adjustment for age, sex, injury type, and hospital characteristics (trauma designation, volume of young children, and hospital region), there were differences in discharge decisions by payer and injury severity. The adjusted percentage discharged of publicly insured children with minor/moderate injury severity was 56.2% (95% CI 51.6, 60.7). The adjusted percentages discharged were higher for both privately insured children at 69.9% (95% CI 64.4, 75.5) and self-pay children at 72.9% (95% CI 67.4, 78.4). The adjusted percentages discharged among severely injured children did not differ significantly by payer. Conclusions The majority of ED visits for young children diagnosed with abuse resulted in discharge. The notable differences in disposition by payer warrant further investigation.