Cost-Drivers in Acute Treatment of Severe Trauma in Europe: A Systematic Review of Literature

Pape, Hans-Christian; Neugebauer, Edmund; Ridley, S.; Chiara, Osvaldo; Nielsen, Tina; Christensen, Michael Cronquist

doi:10.1007/s00068-008-8013-0

Cited by 25 publications

(26 citation statements)

References 30 publications

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“…The challenge for critical care practitioners is to meticulously assess new innovations in therapy and to adopt the most efficient technologies that improve unit function and staff efficiency, and enhance patient outcome at a reasonable cost. 39 As trauma increases as a significant aspect of the global burden of disease, it is imperative that the most common mechanisms are adequately represented in funding models, particularly as trauma patients are likely to sustain injury to multiple body regions. 38,39 In the current study, trauma patients who had the highest cost variance commonly sustained their injury as a result of a fall, a road traffic crash or violence, which is reflective of wider injury patterns.…”

Section: Discussionmentioning

confidence: 99%

“…39 As trauma increases as a significant aspect of the global burden of disease, it is imperative that the most common mechanisms are adequately represented in funding models, particularly as trauma patients are likely to sustain injury to multiple body regions. 38,39 In the current study, trauma patients who had the highest cost variance commonly sustained their injury as a result of a fall, a road traffic crash or violence, which is reflective of wider injury patterns. Injurious falls in the older person population are the leading cause of injury-related mortality and hospitalised morbidity in most developed countries.…”

Section: Discussionmentioning

confidence: 99%

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Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Curtis

Lam²,

Mitchell³

et al. 2014

Aust. Health Review

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Objective. This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix.Methods. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined.Results. There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P < 0.001).Conclusions. AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed.What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Curtis

Lam²,

Mitchell³

et al. 2014

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…Of note, studies indicate that significant reductions in RBCs, FFP and platelets transfusions can be facilitated by using a coagulation factor concentrate-based coagulopathy management in trauma patients [58]. Based upon data from four European countries (UK, Germany, Italy, and Switzerland), blood substitution levels and blood products were calculated and found to account for approximately 27% of all costs associated with trauma care on the intensive care unit [59]. Additional findings include a reduction in septic complications and organ failure which translated into trends towards reduced ventilator time and shorter overall inhospital length of stays.…”

Section: Factor Concentratesmentioning

confidence: 99%

Point of Care and Factor Concentrate-Based Coagulation Algorithms

Theusinger

Stein

Levy

2015

Transfus Med Hemother

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In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.

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“…Based upon data from four European countries (UK, Germany, Italy and Switzerland), blood substitution and blood products were calculated and found to account for approximately 27% of all costs associated with trauma care on the ICU [57]. The reduced frequency of septic complications and organ failure observed here that translated into trends toward reduced days on ventilator while on ICU and shorter overall in-hospital length of stays may also contribute to cost reduction in acute trauma care without increasing the risk for the individual patient.…”

Section: Coagulation Test Incl F XIII F V Inr Pt Apttmentioning

confidence: 99%

Applying ‘Patient Blood Management’ in the trauma center

Theusinger

Stein

Spahn

2014

Current Opinion in Anaesthesiology

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PURPOSE OF REVIEW: The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. RECENT FINDINGS: Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SUMMARY: Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients. Purpose of review The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. Recent findingsEarly administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SummaryApplying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.

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Cost-Drivers in Acute Treatment of Severe Trauma in Europe: A Systematic Review of Literature

Abstract: Irrespective of the idiosyncrasies of the national healthcare systems in Europe, severity of injury, length of stay in ICU, surgical interventions and transfusion requirements represent the key drivers of acute trauma care for severe injury.

Cited by 25 publications

References 30 publications

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

Point of Care and Factor Concentrate-Based Coagulation Algorithms

Applying ‘Patient Blood Management’ in the trauma center

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