The Medical Cost of Abusive Head Trauma in the United States
The Medical Cost of Abusive Head Trauma in the United States
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DOI：
10.1542/peds.2014-0117
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发表时间：
2014-07-01
期刊：
影响因子：
8
通讯作者：
Steinbeigle, Ryan
中科院分区：
文献类型：
--
作者：
Peterson, Cora;Xu, Likang;Steinbeigle, Ryan
目的：摇晃婴儿综合征或儿童虐待性头部创伤（AHT）的健康后果可能是严重和持久的。我们的目的是估计可归因于AHT的多年医疗费用。方法：使用Truven Health MarketScan 2003-2011年的数据，我们确定了0至4岁的儿童，他们有商业或医疗补助保险和AHT诊断。我们使用基于人口统计学和保险特征（如年龄和健康计划类型）的精确病例对照匹配来比较有和没有AHT诊断的患者之间的医疗保健。使用回归模型，我们评估了AHT诊断后4年期间的服务使用（即每位患者的平均年住院次数）以及住院、门诊（包括急诊科）、药物和总医疗费用。结果：我们评估了1209名AHT患者和5895名匹配的对照组。大约48%的AHT患者在最初诊断后2天内接受住院治疗，25%的患者在急诊科接受治疗。AHT诊断与更高的医疗服务使用和更高的住院、门诊、药物和诊断后多年的总费用相关。诊断后4年内AHT患者（2012年美元）的估计总医疗费用为47 952美元（95%可信区间[CI]， 40 219- 55 685美元），而商业保险患者（38 231美元[95% CI， 29 898- 46 564美元]）和医疗补助患者（56 691美元[95% CI， 4290- 69 092美元]）的医疗费用有所不同。结论：儿童在AHT后的数年内仍有大量的超额医疗费用。这些估计数不包括相关的非医疗费用，如特殊教育和残疾费用，这些费用也可归因于辅助医疗。
OBJECTIVES: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.