Page 117 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
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Functional outcome and in-hospital costs after traumatic brain injury
IMPACT methodology, taking a post stabilisation value and if absent work back in time towards prehospital values. Out of 19 missing GCS values, 8 were completed by using emergency department arrival GCS score. Intubation was calculated as a GCS Verbal score of 1. Major extracranial injury was defined by AIS body region ≥3. Characteristics from the first head CT-scan were assessed by a central review panel. 18 Six out of seven missing central assessments were completed by using the assessments of local radiologists. Outcome data included in-hospital mortality and 6-month Glasgow Outcome Score – Extended (GOSE). GOSE outcome was dichotomized in favourable (GOSE≥5) and unfavourable (GOSE≤4). 19
In-hospital healthcare consumption 5 We collected in-hospital healthcare consumption data from electronic patient
records by using a predefined cost assessment database. The Dutch National Health
Care Institute Guidelines for healthcare cost calculation were followed. 20 Units (e.g.
number of admission days, number of diagnostics) were collected independently by two researchers from the electronic patient files. There were five main categories: (1) admission; including length of stay (LOS) in (non-)ICU with consultations, (2) surgical interventions, (3) imaging, (4) laboratory; including blood products and (5) other; including ambulance transportation and outpatient visits. 21 Non-ICU admission was defined as admission to a ward or medium care. In-hospital healthcare consumption and costs were calculated for all included patients. (Supplement 1)
In-hospital costs
We focused on the in-hospital costs from a healthcare perspective. Costs of re- admissions and costs of visits to the Outpatient Clinic related to the trauma were also included. The methods and reference prices as described in the Dutch Guidelines for economic healthcare evaluations were used to calculate in-hospital costs. 20 Costs were calculated by multiplying the number of consumed units with the corresponding guideline reference price. Guideline reference prices are based on non-site specific large patient cohorts which improves their generalizability and interpretation. 20 When reference prices were not mentioned, the remaining units were valued by using amounts per unit as reported by The Netherlands Healthcare Authority (NZa) (i.e. diagnostics) 22 or by using their average national price, based on declared fees (i.e. surgical interventions, consultations). 23 All costs were converted to the last year of patient inclusion (2017) using the national general consumer price index (CBS) and rounded to the nearest ten euros. One EURO equalled $1.05 dollar on the 1st of January 2017. (Supplement 1)
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