Page 127 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Functional outcome and in-hospital costs after traumatic brain injury
the USA are generally double of other high-income countries due to prices of labour, goods, pharmaceuticals and administrative costs, while healthcare utilization was similar. 61 These issues are also reported in non-TBI literature. 62,63
As in other studies, the main cost drivers in this current study were LOS and/or
admission (66%), surgery (12%), radiology (7%), labs (4%) and other costs (11%).
60,64,65 In-hospital costs were generally higher for the more severely injured patients
59,64, with a lower GCS 12,64,66-68 or pupillary abnormalities. 21 Higher costs were related
to an increased healthcare consumption with longer LOS 60,66, specialized intensive
care unit (ICU) treatment 60 and a more frequent use of ICP monitoring 50,65,69 and
surgical procedures. 21,64,70 The presence of TBI normally increases the LOS of general 5 admissions 47, but extracranial injury and higher overall injury severity in addition to
TBI also contributed to higher in-hospital healthcare consumption and in-hospital costs. 49,70,71 It is however impossible to distinguish costs related to extracranial injury from costs related to TBI because these costs are too intertwined.
Compared to the hospital costs for other diseases in the Netherlands, the in-hospital costs for TBI patients were high, especially when TBI severity increased. The hospital costs for patients with ischaemic stroke (€5.328) 72, transient ischaemic attack (€2.470) 72, appendicitis (€3700), colorectal cancer (€9.777 – €19.417) 73 were lower, while costs were higher for patients with non-small cell lung cancer (€33.143) 74 or patients receiving extracorporeal life support treatment (€106.263). 75
Strengths and limitations
The accurate calculation of in-hospital healthcare consumption and in-hospital costs of a large prospective multicenter cohort is a strength of the current study. There are also several limitations. The GCS is usually used to determine TBI severity 24, but its general applicability as a severity measure is also criticized. 76 The GCS could have been influenced by intoxication, pharmacological sedation, prehospital intubation, extracranial injury and could thereby have over- and underestimated injury severity. 77 This could have influenced study results. In a similar way, patient outcome was measured by using in-hospital mortality and GOSE. Critics state that the GOSE insufficiently accounts for the multidimensional nature of TBI outcome. 2 Unfortunately, earlier reported problems with acquiring the disease related health related quality of life outcome measure QOLIBRI resulted in too many missing data points to be useful for this manuscript. 21 Another limitation is the short-term follow up, because it is known that patient outcome and costs can change over time. 43,45,46
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