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The objective of this study was to describe the severity of illness, costs, and outcomes of child abuse (CA) patients in the pediatric intensive care unit (PICU) and to assess the importance of CA in predicting costs adjusting for severity of illness and diagnosis. A retrospective, cohort study was performed on a consecutive sample of 1,376 patients admitted and discharged to a tertiary care PICU during fiscal year 1994. Demographic data, diagnoses, pediatric risk of mortality (PRISM) score, length of stay, and deaths were recorded. Hospital charges were converted into costs using cost:charge ratios. Functional outcomes of the CA patients were assessed at the time of discharge. There were 17 cases of CA in 1,376 admissions (1.24%). CA accounted for 6 of 85 deaths (7.06%) and the mortality rate was significantly higher than the rest of the PICU population (35.3% versus 5.8%, p < 0.01). In the traumatic brain injury (TBI) subgroup, total costs and daily costs were significantly higher in the CA patients ($11,926 versus $7,798, p = 0.013 and $3,400 versus $2,479, p = 0.01). Adjusting for severity of illness with multiple regression, there were no differences in costs identified in the CA patients. Nine of 11 (81.8%) CA patients with TBI were severely disabled or died. CA patients have an increased severity of illness, explaining much of the differences in costs seen with these patients. Further resources should be allocated toward prevention given the high costs and high morbidity and mortality in these patients.