A cost analysis of major traumatic injury

Proceedings

of the British

Trauma

Society

M. G. Chambers, C. M. Airey, S. Chell, A. S. Rigby, J. Connelly, A. Tennant (York, UK and Leeds, UK) A cosf analysis of major fraumafic inju y Individuals who suffer serious injury are significant consumers of health care and other services. Identifying and analysing the costs of care are increasingly important for establishing the financial burden of disease to individuals, society and the NHS, forming the basis for sound service planning, and acting as a baseline for cost-effectiveness studies of interventions in this area. The Yorkshire major trauma study provides a unique opportunity to analyse and compare the costs of initial hospitalization and subsequent care after discharge for a geographically defined cohort, survivors and non-survivors, for incidents occurring in 1 year. Victims of major injuries (Injury Severity Score (ISS)> 15) admitted initially to four hospitals in the region have been selected. Of a total of 328 cases, 221(67 per cent) arrived alive at hospital Accident and Emergency (A&E) resuscitation facilities. Of these, 191 (86 per cent) survived to be admitted to a ward or transferred to another specialist hospital. One hundred and sixteen individuals were eventually discharged alive from hospital, of whom 83 (72 per cent) have been interviewed. This cohort gnerated 9275 bed days of initial (acute) hospital care in the Region, with a median stay of 15 days (range 0-1594, IQR 4-44, mean 50.1 days). Removing one individual who stayed for 1594 days reduces the mean stay to 41.7 days. For survivors, the median stay was 32.0 days (range 3-1594, IQR 15-60, mean 77.9, excluding outlier 64.1 days). Of all bed days 47 per cent were in orthopaedic units, 20 per cent in neurosurgery units, 20 per cent in neurology/spinal injury units, and 5 per cent in intensive care units (ICU). For survivors, the mean stays were 26.9,64.3 and 236.7 days for ISS bands 16-19,20-29 and 30 + respectively. An illustrative analysis of hospital costs gives an estimate of f7092 per admission (El0816 for survivors and f1455 for non-survivors). Total ward treatment costs were El.34m, to which should be added the costs of resuscitation in A&E (221 cases), mortuary/pathology (105 hospital deaths, 107 deaths before arrival), emergency services (328 initial call-outs, 55 transfers and !S re-transfers). Mean hospital costs were f3923, xl0 562 and f27 057 for survivors in ISS bands 15-19, 20-29 and 30 + respectively. Orthopaedics contributed 30 per cent of all costs, neurosurgery 14 per cent, spinal injury 17 per cent and ICU 20 per cent. The most severely injured and disabled generated mean costs of E30 000 and above. Follow-up (hospital) costs averaged f2000 per survivor, with high costs concentrated among the severely disabled. Total direct hospital costs incurred by injuries in 1988-1989 in the Yorkshire region is at least iZ4.9 million, 80 per cent being the cost of initial care of the survivors. Further analysis will compare hospital costs with on-going costs of care, and distinguish between average and marginal costs of care.

V. Neumann, A. Bowen, M. Conner, M. A. Chamberlain (Leeds, UK) Lack of occupation after traumatic brain injury: who is affected? The first 100 consecutive patients recruited to a study conceming rehabilitation following traumatic brain injury (TBI) were assessed 6 months after injury to establish: (i) whether they were occupied pre-injury; (ii) whether they had returned to their occupation; (iii) what differences could be detected between those occupied and not occupied at 6 months. Occupation was defined as including full-time (FT) or parttime (PT) paid work, full-time study or full-time involvement in homecare. All patients had been hospital in-patients for at least 3

369 days following TBI and had no history of significant psychiatric disorder, alcohol or drug abuse. Before their injury 80 were occupied (57 FT, 10 PT, nine FT study, four homecare) and 20 were unoccupied. At 6 months only SO were occupied (36 FT, eight PT, six FT study). Analyses of the 80 patients showed that the occupied and unoccupied groups did not differ with respect to age, sex, duration of post-traumatic amnesia or presence of other injuries. The worst recorded Glasgow Coma Score was lower in the unoccupied group (P
P. Burdett-Smith, M. Airey, A. Franks (Leeds, UK) Improvements in trauma survival in Leeds All cases of major injury (Injury Severity Score (ISS)> 15) admitted to the two Leeds hospitals in 1988-1989 were compared to all cases admitted in 1991-1993, to ascertain if a system of trauma care which had evolved in the hospitals during this time had affected outcome of these patients. Significant improvements in survival were shown especially in less seriously injured patients. Data from an existing Regional study of serious injury were compared to current data collected as part of the MTOS(UK) study. One hundred and eighty-six patients admitted to the two Leeds hospitals in 1988-1989 were compared to 198 cases admitted in 1992-1993. ISS, age, and sex distribution were similar for the two groups. There were significantly fewer deaths in 1992-1993: particularly in those patients with ISS < 41. This shows that although the anatomical indicators of injury did not change, the deleterious physiological effects of trauma were better corrected in the later group. This would suggest that early treatment had improved over the study period. The changes that had occurred included regular Advanced Trauma Life Support (ATLS) courses being run in Leeds, increased senior medical staff presence in the Accident and Emergency departments, nurse training in ATNC, the development of trauma teams, regular multi-disciplinary trauma audit meetings and a general raising of awareness of the importance of rapid treatment of the seriously injured. The emphasis, since 1988, on timely and definitive manage-