Costs of acute care hospitalization in multiple trauma patients

Current clinical management after multiple trauma is expensive. The aim of the present study was to quantify the actual costs of inpatient treatment a fter multiple trauma in a German university hospital, to compare the actual costs with the reimbursement rates, and to identify important determinants of costs. Routine documentation of hospital costs at a patient level was n ot available. Therefore a method for calculating the costs of resource util ization during clinical treatment of patients was developed. The concept was based on financial and utilization data provided by the hos pital administration and patient-specific data. The average costs per case in the study group (mean ISS=37) were 73.613 DM, maximal costs were up to 2 92.490 DM. The most costly components were intensive care, accounting for 6 0%, followed by procedures in the operating room (24%). A comparison with t he reimbursement rates resulted in an average loss of 23.211 DM per case. Factors significantly associated with the costs of acute care hospitalizati on were outcome, injury severity, pattern of injury, blood volume replaceme nt, length of mechanical ventilation, and number of operations. Whereas pat ient age, CNS state, mechanism of injury, pre-hospital care, and time betwe en accident and hospital admission revealed no effect. Given the current re imbursement rates, multiple trauma care clearly belongs to those categories of care which have to be subsidized within the hospital. Any challenge to the optimal level of care resulting from this should be avoided.