Use of health services by children who were identified during the postpartum period as being at high risk of child abuse or neglect

Objective. To examine the rates of hospitalizations of children identified as being at high risk of maltreatment compared with a sociodemographically similar comparison group. Design. Retrospective study comparing a high-risk cohort with a sociodemographically matched comparison group at Yale-New Haven Hospital (New Haven, CT). Patients. One hundred fourteen children who were identified from January 1979 through December 1981 by clinicians on the postpartum ward as being at high risk of abuse or neglect and 114 sociodemographically similar comparison children who were matched according to date of birth, race, gender, and method of payment for the hospitalization. Main Outcome Measurer. During the first 4 years of life, the number of hospitalizations, reasons for admissions, and appropriateness of days in the hospital using the Pediatric Appropriateness Evaluation Protocol. Results. Significantly more high-risk children were hospitalized (40% vs 22%; risk ratio, 1.84; 95% confidence interval, 1.23-2.74). High-risk children were hospitalized for 649 (mean, 9.0) days versus 124 (mean, 3.8) days in comparison children. For admissions for medical problems, 28% of hospital days in the high-risk group were considered inappropriate by the Pediatric Appropriateness Evaluation Protocol versus 8% in the comparison group. Conclusions. There are substantial differences in the rates of hospitalizations, lengths of stay, and appropriateness of days in children identified as being at high risk of maltreatment compared with a sociodemographically similar, non-high-risk group. Preventive programs that are aimed at reducing rates of child maltreatment in high-risk young children also should examine the program's effects on the use of hospital care.