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{
    "pk": 8656,
    "title": "Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance",
    "subtitle": null,
    "abstract": "Introduction\n: Limited data are available regarding differences in presentation and management of pediatric emergency department (PED) patients based on insurance status. The objective of the study was to assess the difference in management of pediatric facial lacerations based on medical insurance status.\nMethods\n: We conducted a retrospective cohort study with universal sampling of patients with facial lacerations who were treated in an urban PED (45K visits/year) over a one-year period. Demographic features and injury characteristics for patients with commercial (private) insurance and those with Medicaid or Medicare (public) insurance were compared.\nResults\n: Of 1235 children included in the study, 667 (54%) had private insurance and 485 (39%) had public insurance. The two groups did not differ in age or gender, arrival by ambulance, location of injury occurrence, mechanism of injury, part of face involved, length or depth of laceration, use of local anesthetic, or method of repair but differed in acuity assigned at triage. Patients with public insurance were found less likely to have subspecialty consultation in bivariable (OR=0.41, 95% CI [0.24–0.68]) and multivariable logistic regression analyses (OR=0.45, 95% CI [0.25-0.78]). Patients with public insurance received procedural sedation significantly less often than those with private insurance (OR=0.48, 95% CI [0.29-0.76]). This difference was not substantiated in multivariable models (OR=0.74, 95% CI [0.40-1.31]).\nConclusion\n: Patients with public insurance received less subspecialty consultation compared to privately insured patients despite a similarity in the presentation and characteristics of their facial lacerations. The reasons for these disparities require further investigation. [West J Emerg Med 2015;16(4)-0.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Disparities, insurance, facial laceration, pediatrics, presentation, management"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0xr9t6w0",
    "frozenauthors": [
        {
            "first_name": "Siraj",
            "middle_name": "",
            "last_name": "Amanullah",
            "name_suffix": "",
            "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island",
            "department": "None"
        },
        {
            "first_name": "James",
            "middle_name": "G.",
            "last_name": "Linakis",
            "name_suffix": "",
            "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island",
            "department": "None"
        },
        {
            "first_name": "Patrick",
            "middle_name": "M.",
            "last_name": "Vivier",
            "name_suffix": "",
            "institution": "Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island; School of Public Health at Brown University, Providence, Rhode Island",
            "department": "None"
        },
        {
            "first_name": "Emily",
            "middle_name": "",
            "last_name": "Clarke-Pearson",
            "name_suffix": "",
            "institution": "Harvard Medical School, Department of Plastic Surgery, Cambridge, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Dale",
            "middle_name": "W.",
            "last_name": "Steele",
            "name_suffix": "",
            "institution": "Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island; Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island",
            "department": "None"
        }
    ],
    "date_submitted": "2014-12-13T04:46:28Z",
    "date_accepted": "2014-12-13T04:46:28Z",
    "date_published": "2015-07-02T21:48:41Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8656/galley/4975/download/"
        }
    ]
}