A Cost Analysis of a Validated Screening Tool for Pediatric Abusive Head Trauma

Doctors who treat young victims of trauma are required to make important decisions to launch or forgo child abuse evaluations in their acutely head-injured patients. To improve the accuracy of these decisions, Pediatric Brain Injury Research Network (PediBIRN) investigators derived and validated a 4-variable clinical prediction rule (CPR) that improves the detection of abusive head trauma (AHT) in pediatric intensive care units. Our objective was to estimate and compare medical costs from the health system perspective of AHT screening guided by the CPR vs. screening as usual (SAU). Cost estimates for child abuse evaluations, emergency department (ED)/pediatrician visits, and hospital admissions for AHT were combined with published data on service use and re-injury rates in children with missed or unrecognized AHT. Applying published estimates of the CPR’s potential screening performance, the cost per correctly identified child with AHT was calculated and compared for AHT screening guided by the CPR vs. SAU, and the potential medical cost savings associated with CPR application was estimated. Applied accurately and consistently, the CPR could reduce the cost per correctly identified child with AHT by 15.1%, and reduce health system costs resulting from missed AHT by 72.4%.