The Incremental Hospitalization Cost of Significant Transport-Related Traumatic Brain Injury

Abstract

Aim: This study aims to determine the incremental cost of acute hospitalization for traumatic brain injury (TBI) compared with matched controls. A second purpose is to identify the factors contributing to this hospital costs. Methodology: Analyses were performed on administrative data for injured patients, hospitalized in Belgium between 2009 and 2011 following a road traffic accident. Cases were matched to a control with similar injuries but without TBI. The incremental hospitalization cost of TBI and the factors contributing to the hospital costs were determined using multivariable regression modeling with gamma distribution and log link. Results: A descriptive comparison of cases and controls shows clear differences in healthcare utilization and costs. The presence of a TBI increases the cost by a factor between 1.66 (95% confidence interval: 1.52-1.82) and 2.08 (95% confidence interval: 1.72-2.51). Regarding healthcare utilization, the most important determinants of hospital costs are surgical complexity, use of magnetic resonance imaging, intensive care unit admission, and mechanical ventilation. Discussion: To our knowledge, this is the first matched-control study calculating the incremental hospitalization cost of TBI. The insights provided by this study are relevant in the context of prospective payments and can be an incentive for investments in prevention policies and extramural care.

Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN)

“…This study offers fresh insights that are useful for those providing clinical care on scene, planning extrication strategies and supporting clinicians in enabling patients to self-extricate. Injuries of the head, thorax, face and limb are unlikely to benefit from a longer extrication strategy based on movement mitigation when other quicker routes such as self-extrication could be considered; these injuries may be time dependent and the extended time these patients remain in the vehicle will add to excess mortality related to bleeding and hypoxia [ 10 , 17 ]. Gentle patient handling and movement mitigation may help with prevention of clot disruption in abdominal or pelvic injury [ 18 ], but these significant injuries often require blood product resuscitation and early access to hospital-based services for identification of injury (CT scan) and treatment (interventional radiology or damage control surgery) [ 19 ].…”

“…With this changing demographic, healthcare systems have witnessed a disproportionate rise in older patients suffering from major trauma, with this group now representing over 50% of the major trauma cases reported in the UK [ 8 , 9 ]. There are more older drivers and passengers on the roads than ever before, with older road users representing 12% of car driving license holders and 9% of road miles travelled [ 10 , 11 ]. Older patients have a higher mortality rate, with those over 70 representing a disproportionate 20% of all car driver deaths [ 12 ].…”

Health care costs and lost productivity costs related to excess weight in Belgium

“…The inclusion of the costs of the previous year in the analysis was considered to not be pertinent to compute incremental costs for overweight and obesity. These choice is more comment in case of cute onset of disease/injury [ 32 , 33 ]. A further limitation is the possibility of residual confounding bias in the cost estimation.…”

Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies

“…Traumatic brain injury (TBI) is a burdening condition in both acute and chronic phases, with patients exhibiting post-TBI outcomes that affect their overall functioning [ 1 ], return to society [ 2 ], and inflict a socio-economic burden on their caregivers [ 3 , 4 ]. It represents a major public health problem that causes over 27 million new cases worldwide within a year, putting tremendous pressure on health systems in low-and middle-income countries (which have the highest-burden regarding the number of cases) and high-income countries alike [ 5 ].…”