Page 17 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
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 Table 1 Explanation of Glasgow Outcome Scale (- Extended). 43
Glasgow Outcome Scale Glasgow Outcome Scale – (GOS) Extended (GOSE)
Brief description
Death
Absence of awareness of self and environment
Needs full assistance in daily life Needs partial assistance in daily life
Independent, but cannot resume work/ school or all previous social activities Some disability exists, but can partly resume work or previous activities
Minor physical or mental deficit that affects daily life
Full recovery or minor symptoms that do not affect daily life
U/F
1
1. Death
2. Vegetative state
3. Severe disability
4. Moderate disability
5. Good recovery
1. Death
2. Vegetative state
3. Lower severe disability 4. Upper severe disability
5. Lower moderate disability
6. Upper moderate disability
7. Lower good recovery 8. Upper good recovery
General introduction
   Patient outcome after TBI and thereby the
unproven, treatment strategies is still considered to be unsatisfactory. 1,9,21,24,29 A critical appraisal of treatment effectiveness and patient outcome will hopefully decrease the number of patients that achieve an outcome that they would have never wanted and might even prevent associated but ineffective healthcare expenses. 9,54-56
In-hospital costs
The annual global economic burden of TBI is estimated to be US$ 400 billion. 1 Direct costs (i.e. healthcare costs) represent a substantial part of the total economic burden 3,57-60, but the indirect costs (i.e. loss of productivity and intangible costs) are considered to be the largest contributor. 1,61,62 TBI related healthcare costs are increasing annually, which is problematic when healthcare budgets remain restricted. 63-65 These high and rising healthcare costs could endanger the affordability of national healthcare systems and thereby public health. 66,67 The importance of investigating the cost of care for TBI patients is therefore widely recognized by healthcare professionals and societies. 1 Healthcare professionals and policy makers are nowadays even expected to study the cost-effectiveness of treatments. 68,69
When focussing on the hospital setting, patients with s-TBI show the longest hospital or ICU length of stay and have the most (neuro)surgical and medical interventions compared to other TBI severities. 42,70,71 These patients also show the highest individual costs of all TBI patients. 70 In The Netherlands, the mean direct and indirect costs for TBI patients were €18,030 per patient 3, and when including rehabilitation and nursing home costs, patients with s-TBI costed €40,680 to €44,952. 72
effectiveness of available, generally
15
Favourable outcome Unfavourable outcome




































































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