Background
Methods
Retrieval of articles
Term | |
---|---|
POPULATION
| |
#1 | exp. Wounds and injuries (MeSH) |
#2 | ((acute or severe) adj3 (trauma or injury or injuries)).mp |
INTERVENTION/EXPOSURE
| |
#3 | Trauma Centers/ |
#4 | exp. Emergency Service, Hospital/ |
OUTCOME
| |
#5 | Economics, Hospital/ |
#6 | Hospital Costs/ |
#7 | “Costs and Cost Analysis”/ |
#8 | exp Diagnosis-Related Groups/ |
#9 | ((cost* or burden*) adj3 (hospital* or “trauma centre*”)).mp |
SEARCH STRATEGY
| |
#10 | 1 OR 2 |
#11 | 3 OR 4 |
#12 | 5 OR 6 OR 7 OR 8 OR 9 |
#13 | 10 AND 11 AND 12 |
Total
|
443
|
Article inclusion
Data extraction
Secondary article exclusion
Study assessment
Cost estimation evaluation | Number of studies |
---|---|
Included
| |
Variable costs
| |
Surgical procedures | 11 |
Materials and supply costs | 5 |
Length of stay (A&E, general ward, ICU) | 6 |
Days spent on mechanical ventilation | 2 |
Maintenance | 1 |
Salaries | 4 |
Reimbursements | 3 |
Transportation | 2 |
Laboratory services | 8 |
Radiology services | 4 |
Pharmacy services | 2 |
Emergency services | 2 |
Pathology services | 8 |
Fixed costs
| |
Overheads | 4 |
Depreciation | 1 |
Unspecified | 4 |
Excluded
| |
Physician charges | 5 |
Nursing costs | 1 |
Specialist and ancillary services | 3 |
Non-medical resources | 5 |
Pre-clinical emergency | 4 |
Post patient rehabilitation | 3 |
Food and medication costs | 1 |
General hospital overheads | 2 |
Unspecified | 15 |
Measured
| |
Medical records | 9 |
Trauma registry | 12 |
Audit of medical records | 1 |
Local government departments | 1 |
Health plan database | 1 |
Unspecified | 3 |
Valued
| |
Cost accounting system | 7 |
Reimbursement data | 3 |
Hospital billed charges | 2 |
National cost utilisation project | 1 |
Hospital finance department | 7 |
Local health departments | 2 |
Cost source websites | 2 |
Hospital cost to charge ratio | 1 |
Unspecified | 2 |
Analysis
Author (year) | Country | Number of participants (n) | Type of trauma | Mean ISS | Mean cost per trauma admission ($USD) | Mean charge per trauma admission ($USD) |
---|---|---|---|---|---|---|
Thomas (1988)
| USA | 340 | Polytrauma | 26+/-17 | 33701+/-36843 | |
Buckley (1994)
| USA | 805 | Polytrauma | 10.9 | 16666 | |
Mock (1994)
| USA |
GSW: 1116 | Penetrating |
GSW: 13.7 |
GSW:23313+/-42504 | |
SW: 529 |
SW: 7.6 |
SW: 10334+/-117939 | ||||
Kizer (1995)
| USA | 750 | Penetrating | 13(1-50) | 22115 | |
10* | 12768* | |||||
Spaite (1995)
| USA | BAL=>0mg/dL:29 | Polytrauma |
Group 1:10.3 |
Group 1: 11553; (89-209975) | |
BAL=0mg/dL:321 |
Group 2: 33 |
Group 2: 1875; (56-71448) | ||||
Goldfarb (1996)
| USA | 6963 | Polytrauma | 18.31+/-6.01 | 29598 | |
27349* | ||||||
OKeefe (1997)
| USA | 12088 | Polytrauma Blunt Penetrating | 11.2+/-9.1 | 23399+/-37134 | |
Rogers (1997)
| USA | 1179 | Poiytrauma | 96+/-7.8 |
ISS 0-16: 8666 | |
ISS 17-25: 22979 | ||||||
ISS>25: 57559 | ||||||
Young (1998)
| USA |
Group I (18-64 yr): 828 | Polytrauma |
Group 1: 13.8+/-10.7 |
Group 1: 24970 +/-4235 | |
Group 2 (>65yr):159 |
Group 2: 162+/-11.1 |
Group 2:21602 +/- 37922 | ||||
Taheri (1998)
| USA | 361 | Polytrauma |
Group 1: 14.4+/-0.5 |
Group 1: 15053 | |
Group 2: 14.7+/-0.5 |
Group 2: 11036 | |||||
Sartorelli (1999)
| USA | 1179 | Polytrauma | 7.2+/-7.6 | 12988+/-21549 | |
Kaya (1999)
| Turkey | 347 | Polytrauma | 13.3+/-0.5 | 69839 | |
Taheri (1999)
| USA | 696 | Polytrauma | >15 | 14564 | |
Rösch (2000)
| Germany | 39 | Polytrauma | 37 | 111209 | |
Dueck (2001)
| Canada | 223 | Polytrauma | 18.8 | 8196 | |
5226* | ||||||
Park (2001)
| USA | 204 | Polytrauma |
TICU:25.8+/-7.9 |
TICU: 173013; 119397* | |
SICU:27.1+/-9.2 |
SICU:211130; 166653* | |||||
Schmelz (2002)
| Germany | 71 | Polytrauma | 23 | 32851 | |
Ganzonie (2003)
| Switzerland | 35 | Polytrauma | 33.9 (25-66) | 95380 | |
Lanzorotti (2003)
| USA | 2634 | Polytrauma | 11.9 +/- 9.2 (1-75) | 13096+/- 27003; (837-418553) | |
Grotz (2003)
| Germany | 103 | Polytrauma | 29.4 | 41522 | |
Sikand (2005)
| UK | 171 | Polytrauma | >15 | 27542; (3216-96558) | |
Small (2006)
| Australia | 180 | Pedestrian | 14.1 | 22713 | |
Davis (2007)
| USA | 12615 | Blunt Penetrating & TBI | 10.67 | 60094 | |
Christensen (2008)
| UK | 36564 | Blunt |
ISS 0-9: 60% |
ISS 0-9: 11248; 8471* | |
ISS 10-16: 17% |
ISS 10-16: 16313; 10330 | |||||
ISS 17-25: 12% |
ISS 17-25: 25780; 16123 | |||||
1SS26-75: 11% |
ISS 26- 75: 38426; 27297 | |||||
Total: 17295+/-21546; 9782* (6580-17812) | ||||||
Christensen (2008)
| UK | 1365 | Penetrating |
ISS 1-8:16% |
ISS 1-8: 11798; | |
ISS 9-15: 50% | 8580* | |||||
ISS 16-24: 15% |
ISS 9-15: 10952; 8568* | |||||
ISS 25-45: 16% |
ISS 16-24: 17155; 13099* | |||||
ISS 46-75: 41% |
ISS 25-45: 22408; 13386* | |||||
ISS 46-75: 29832; 19551* | ||||||
Total: 14488; 9932* (5976-16034) | ||||||
Zarzaur (2010)
| USA | 1914 | Blunt | 23.3 +/- 7.2 | 11541 +/-18681 5620* | |
Rowell (2011)
| Australia | 72 | Polytrauma | 28.13+/-9.92 | 43547 34350* |
Results
Country | Number of articles | Median $US cost (IQR) | Median $US charge (IQR) |
---|---|---|---|
USA
| 16 | 22,115 (13,776-29,335) | 14,881 (8,219- 27,523) |
UK
| 3 | 18,535 | |
(11,819-25,827) | |||
Germany
| 3 | 41,522 (37,186-76,365) | |
Australia
| 2 | 33,130 (27,907-38,297) | |
Switzerland
| 1 | 95,380 | |
Turkey
| 1 | 69,839 | |
Canada
| 1 | 8,196 | |
Total
|
27
|
*22,448 (11,819-33,701)
|
**26,030 (13,988-28,199)
|