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The complications of trauma and their associated costs in a level 1 trauma center
LITERATURE REVIEW
Abstracts & Comments David J. Dries, MSE, MD, FACS, FCCP, FCCM This section examines emerging research through a review of abstracts from current literature. Each abstract is documented to show the publication in which it has appeared. David J.
The Complications
of lkauma
and their
Dries, Air Medical Journal coeditor, has reviewed the research to write the comments that appear with the abstracts.
Associated
Costs
in a Level
1 Ikauma
Center
O’Keefe GE, Maier RV, Diehr P, Grossman D, Jurkovich GJ, Conrad D. Arch Surg 1997:132:920-4. Objectives. To estimate the expected costs for acute trauma care, quantify the costs associated with the development of complications in injury victims, and determine the deficit incurred by patients in whom complications develop Design. A retrospective, cohort design Setting. A referral Level 1 trauma center Patients. A total of 12,088 patients admitted to a single regional trauma center during a period of 5 years interventions. This is an observational study, and no interventions specific to this study are included in the design. Main Outcome Measures. The expected costs for injury victims based on readily available clinical data; the costs associated with the most important
complications of trauma; the effect of complications on inadequate reimbursement for trauma care Results. The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14,567, and the observed costs averaged $15,032. Six complications were important cost predictors: adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23,266, and the observed costs averaged $47,457. The mean excess costs for a single compli-
cation began at $6669 and led to greater increases in excess cost, averaging $18,052. Multiple complications averaged $110,007 for 62 patients with three or more complications. Costs exceeded reimbursement to a much greater degree in patients in whom any of the six complications developed. Conclusion. Expected hospital costs can be estimated using admission clinical data. Each of six complications was associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.
The authors demonstrate that impor- trol of health care providers is unclear. tant predictors of cost in the provision of Evaluation of trauma cost in our medical trauma care are similar to factors used to center suggests a significant portion of estimate expected mortality among expenses in managing the trauma patient trauma victims. This report is similar to is beyond the practicing surgeon’s conother studies with respect to variables trol. Therefore laying the burden of cost used and combination methods for statis- reduction solely on changes in physician tical examination. behavior is inappropriate. As the authors note, this report is limClearly this study and others like it ited to data obtained from a retrospective may be used to demonstrate to prospectrauma registry. Data were not collected tive payment systems that certain factors specifically for this study, leading to po- associated with hospitalization for injury tential bias. In addition, whether costs identified at admission can predict indescribed are inherent in the hospital creased hospital stay and associated portion of charges or are under the con- costs. A host of other studies support the
assertion that, however damaging these complications, which are noted in an excellent trauma center, the likelihood of adverse outcome is increased significantly when care for injured patients is provided elsewhere than the facilities and individuals with resources dedicated to this activity. Finally, expanding research such as this to develop a combined database from multiple centers will allow resource allocation to optimal strategies to manage and prevent not only injury but its complications.
COMMENT
134
July-September1998 17:3 Air Medical Journal
Abstracts & Comments David J. Dries, MSE, MD, FACS, FCCP, FCCM This section examines emerging research through a review of abstracts from current literature. Each abstract is documented to show the publication in which it has appeared. David J.
The Complications
of lkauma
and their
Dries, Air Medical Journal coeditor, has reviewed the research to write the comments that appear with the abstracts.
Associated
Costs
in a Level
1 Ikauma
Center
O’Keefe GE, Maier RV, Diehr P, Grossman D, Jurkovich GJ, Conrad D. Arch Surg 1997:132:920-4. Objectives. To estimate the expected costs for acute trauma care, quantify the costs associated with the development of complications in injury victims, and determine the deficit incurred by patients in whom complications develop Design. A retrospective, cohort design Setting. A referral Level 1 trauma center Patients. A total of 12,088 patients admitted to a single regional trauma center during a period of 5 years interventions. This is an observational study, and no interventions specific to this study are included in the design. Main Outcome Measures. The expected costs for injury victims based on readily available clinical data; the costs associated with the most important
complications of trauma; the effect of complications on inadequate reimbursement for trauma care Results. The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14,567, and the observed costs averaged $15,032. Six complications were important cost predictors: adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23,266, and the observed costs averaged $47,457. The mean excess costs for a single compli-
cation began at $6669 and led to greater increases in excess cost, averaging $18,052. Multiple complications averaged $110,007 for 62 patients with three or more complications. Costs exceeded reimbursement to a much greater degree in patients in whom any of the six complications developed. Conclusion. Expected hospital costs can be estimated using admission clinical data. Each of six complications was associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.
The authors demonstrate that impor- trol of health care providers is unclear. tant predictors of cost in the provision of Evaluation of trauma cost in our medical trauma care are similar to factors used to center suggests a significant portion of estimate expected mortality among expenses in managing the trauma patient trauma victims. This report is similar to is beyond the practicing surgeon’s conother studies with respect to variables trol. Therefore laying the burden of cost used and combination methods for statis- reduction solely on changes in physician tical examination. behavior is inappropriate. As the authors note, this report is limClearly this study and others like it ited to data obtained from a retrospective may be used to demonstrate to prospectrauma registry. Data were not collected tive payment systems that certain factors specifically for this study, leading to po- associated with hospitalization for injury tential bias. In addition, whether costs identified at admission can predict indescribed are inherent in the hospital creased hospital stay and associated portion of charges or are under the con- costs. A host of other studies support the
assertion that, however damaging these complications, which are noted in an excellent trauma center, the likelihood of adverse outcome is increased significantly when care for injured patients is provided elsewhere than the facilities and individuals with resources dedicated to this activity. Finally, expanding research such as this to develop a combined database from multiple centers will allow resource allocation to optimal strategies to manage and prevent not only injury but its complications.
COMMENT
134
July-September1998 17:3 Air Medical Journal