Table 2.
Factors Associated With Per-Visit Hospital Costs for Pediatric Abusive Head Trauma, 2006–2011.
| Emergency Department Treat and Release Visits (N = 6,827)
|
Inpatient Admissions (N = 12,533)
|
||||
|---|---|---|---|---|---|
| Category | Factor | n (%) survey weighteda | exp(β),95% CI | n (%) survey weighteda | exp(β),95% CI |
| Age | <1 year | 3,004 (44) | (Reference) | 9,263 (74) | (Reference) |
| 1–4 years | 3,823 (56) | 0.77 [0.65, 0.90]* | 3,270 (26) | 1.09 [0.89, 1.33] | |
| Sex | Female | 3,005 (44) | (Reference) | 5,098 (41) | (Reference) |
| Male | 3,822 (56) | 1.11 [0.93, 1.32] | 7,435 (59) | 1.13 [1.02, 1.26]* | |
| Race | White | NR | — | 4,732 (38) | (Reference) |
| Black | NR | — | 1,856 (15) | 1.07 [0.86, 1.34] | |
| Hispanic | NR | — | 2,059 (16) | 1.12 [0.92, 1.36] | |
| Other | NR | — | 988 (8) | 1.09 [0.85, 1.39] | |
| Unknown | NR | 2,897 (23) | 1.13 [0.90, 1.43] | ||
| Chronic conditionb | No | 6,291 (92) | (Reference) | 9,486 (76) | (Reference) |
| Yes | 536 (8) | 2.63 [1.52, 4.57]* | 3,047 (24) | 1.66 [1.43, 1.94)** | |
| Admission source | Routinec | NA | — | 3,278 (26) | (Reference) |
| ER | NA | — | 5,640 (45) | 1.02 [0.84, 1.25] | |
| Another facility | NA | — | 3,576 (29) | 1.19 [0.96, 1.47] | |
| Unknown | NA | 39 (0) | 0.30 [0.14, 0.62])* | ||
| Discharge status | Routined | 5,711 (84) | (Reference) | 9,824 (78) | (Reference) |
| Another facility | 1,081 (16) | 3.04 [2.49, .71]** | 1,379 (11) | 2.20 [1.78, 2.73]** | |
| Died | 35 (1) | 3.70 [1.97, 6.97]** | 1,330 (11) | 1.59 [1.25, 2.03]** | |
| Household income quartile | 1 | 2,543 (37) | 0.97 [0.74, 1.25] | 4,349 (35) | 0.78 [0.61, 0.99]* |
| 2 | 2,102 (31) | 1.01 [0.77, 1.31] | 3,594 (29) | 0.83 [0.64, 1.07] | |
| 3 | 1,233 (18) | 0.84 [0.65, 1.10] | 2,672 (21) | 0.87 [0.69, 1.10] | |
| 4 (Highest income) | 844 (12) | (Reference) | 1,585 (13) | (Reference) | |
| Unknown | 105 (2) | 0.80 [0.56, 1.15] | 332 (3) | 0.70 [0.51, 0.97]* | |
| Primary payer | Private | 1,889 (28) | (Reference) | 2,149 (17) | (Reference) |
| Public (Medicare/Medicaid) | 4,093 (60) | 1.33 [1.09, 1.61)* | 9,474 (76) | 1.11 [0.92, 1.34) | |
| Self-pay | 571 (8) | 0.91 [0.69, 1.22] | 298 (2) | 1.05 [0.61, 1.83] | |
| Unknown | 274 (4) | 1.12 [0.77, 1.64] | 611 (5) | 1.20 [0.86, 1.68] | |
| ED trauma level | Nontrauma | 3,238 (47) | (Reference) | — | — |
| Trauma | 3,589 (53) | 1.34 [1.07, 1.69]* | — | — | |
| Hospital size | Small | NR | — | 1,487 (12) | 1.3 [0.93, 1.80] |
| Medium | NR | — | 2,233 (18) | 1.07 [0.86, 1.33] | |
| Large | NR | — | 8,497 (68) | (Reference) | |
| Unknown | NR | — | 317 (3) | 0.84 [0.59, 1.19] | |
| Hospital location and teaching status | Rural | 1,213 (18) | 0.61 [0.45, 0.83]* | 311 (2) | 0.61 [0.33, 1.13] |
| Urban, nonteaching | 2,078 (30) | 0.65 [0.51, 0.84]* | 1,167 (9) | 0.88 [0.66, 1.19] | |
| Urban, teaching | 3,536 (52) | (Reference) | 10,738 (86) | (Reference) | |
| Unknown | 0 | NA | 317 (3) | NR | |
| Hospital region | Northeast | 1,674 (25) | (Reference) | 1,858 (15) | (Reference) |
| Midwest | 1,914 (28) | 0.97 [0.69, 1.38] | 3,037 (24) | 0.89 [0.62, 1.28] | |
| South | 2,792 (41) | 1.33 [0.94, 1.89] | 4,997 (40) | 0.8 [0.57, 1.13] | |
| West | 448 (7) | 1.04 [0.67, 1.63] | 2,641 (21) | 0.94 [0.66, 1.35] | |
| Year | 2006 | 1,094 (19) | (Reference) | 1,961 (19) | (Reference) |
| 2007 | 1,223 (18) | 0.91 [0.72, 1.15] | 2,075 (17) | 0.98 [0.70, 1.37] | |
| 2008 | 1,161 (17) | 0.86 [0.67, 1.11] | 1,983 (16) | 0.91 [0.66, 1.27] | |
| 2009 | 1,154 (17) | 1.03 [0.80, 1.32] | 2,036 (16) | 0.84 [0.65, 1.09] | |
| 2010 | 1,009 (15) | 0.81 [0.61, 1.09] | 2,688 (21) | 1.08 [0.82, 1.44] | |
| 2011 | 1,186 (17) | 1.24 [0.75, 2.06] | 1,790 (14) | 0.96 [0.72, 1.3] | |
Note. Data are results from multivariable generalized linear models with log link, gamma variance, and survey design. In the calculation of standard errors, strata with single sample units (ED: n = 23/111 strata; inpatient: 19/46 strata) used an average of the variances from other strata with multiple sampling units (StataCorps, 2013). Models included all listed variables. ED = emergency department, exp(β) = exponentiated coefficient (interpreted as a multiplicative change in the dependent variable—total cost per visit—associated with a unit change in an independent variable), NA = not applicable, NR = not reported, 95% CI = confidence interval.
Survey data reweighted to accommodate missing cost data: ED: n = 889/6,827 (13%); inpatient: n = 88/12,533 (<1%; Healthcare Cost and Utilization Project, 2013a).
Chronic conditions defined as the following conditions (ICD-9-CM codes) documented on discharge records: epilepsy/recurrent seizures (345), developmental delays (315), other nervous symptoms (781), congenital anomalies (740–759), conditions originating in the perinatal period (760–779), and other chronic conditions (299, 343, 317–319, 677, 369, and 389) (Niederkrotenthaler et al. 2013).
Includes birth and unspecified admissions.
Includes patients discharged: against medical advice; alive, destination unknown; to court or law enforcement; and to home health care.
p < .05.
p < .001.