Page 82 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 3
Fourteen studies reported LOS for patients with s-TBI, also showing major variation (Fig 3). 35,36,38,40,43,45-47,50-52,54-56 ICU LOS ranged from 7.9 to 25.8 days (GCS≤8) 40,43, 6 to 19 days (AIS≥4) and 6 to 21 days (AIS≥5). 35,47 Hospital LOS ranged from 10 to 36.8 days (GCS≤8) 38,54, 10 to 26.1 days (AIS≥4) 47,52 and 11 to 17.5 days (AIS≥5). 46,47
Some studies reported costs related to acute care to be 46% to 67% of total hospitalization costs, while inpatient rehabilitation costs accounted for 26% to 41%. 41,42,54,57 Various studies found that costs related to hospital LOS and ICU LOS were the main drivers of hospital costs. 36,38,39,47,50,53 Costs related to ICU care comprised the biggest part of total hospital costs (51-79%), followed by costs related to ward admission (12-38%), surgery (4-8%) and imaging/laboratory (<3%). 36,38,47 Physician charges were reported to be 12% to 20% of total costs. 39,41 One study included the salary of paramedics and found salary to be the most important contributor (71-79%) to total provider costs. 39,41,51 The majority of costs, up to 90%, were made in the first year after trauma and were generally associated with TBI-related hospitalization costs. 41,48,57 The share of acute hospital services (18%) and rehabilitation (27%) on total costs decreased when a long-term follow-up period was used. 52
Several studies provided some additional information on clinical factors that were associated with reported costs. A higher TBI severity was generally related with an increased LOS and costs. 34,35,37-39,41,42,46-50,53,54 Even among patients with a s-TBI, patients with a GCS3-5 or AIS=5 were more expensive than patients with a GCS6-8 or AIS=4, respectively. 34,35,39,40,46,47,54 A higher overall injury severity was also related with higher costs. 39,47,53 Male gender was linked with higher costs 35,39,53 and two studies mentioned that a higher age was more expensive. 47,50 Costs were also influenced by trauma mechanism and were higher for motor vehicle accidents and gunshot wounds and lower after an assault to the head. 34,35,39,46,53,54 The use of surgical intervention, intracranial pressure monitoring or mannitol were all related to longer LOS and higher costs. 37,38,45,53,54 Also, the introduction of guidelines and evidence based medicine protocols appeared to increase LOS and hospital costs 43,55, while improvement of guideline adherence did not change ICU and hospital costs in another study. 36 Three studies related costs to outcome and found lower costs for patients that died or made a good recovery. 37,53,58
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