THE COMPLICATIONS OF TRAUMA AND THEIR ASSOCIATED COSTS IN A LEVEL-I TRAUMA CENTER

Objectives: To estimate the expected costs for acute trauma care, to q uantify the costs associated with the development of complications in injury victims, and to determine the deficit incurred by patients in w hom complications develop. Design: A retrospective, cohort design. Set ting: A referral trauma center. Patients: A total of 12088 patients ad mitted to a single regional trauma center during a period of 5 years. Interventions: This is an observational study, and no interventions sp ecific to this study are included in the design. Main Outcome Measures : (1) The expected costs for injury victims based on readily available clinical data. (2) The costs associated with the most important compl ications of trauma. (3) The effect of complications on inadequate reim bursement for trauma care. Results: The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14567, and the observ ed costs averaged $15032. Six complications were important predictors of cost. These included adult respiratory distress syndrome, acute kid ney failure, sepsis, pneumonia, decubitus ulceration, and wound infect ions. For 1201 individuals with these complications, the predicted cos ts averaged $23266 and the observed costs averaged $47457. The mean ex cess costs for a single complication ranged from $6669 to $18052. Mult iple complications led to greater increases in excess cost, averaging $110007 for the 62 patients with 3 or more complications. Costs exceed ed reimbursement to a much greater degree in those in whom any of the 6 complications developed. Conclusion: Expected hospital costs can be estimated using admission clinical data. Each of 6 complications was a ssociated with enormous increases in costs, indicating their importanc e as a cause of avoidable expenditures in injury victims and identifyi ng situations in which reimbursement may not be adequate.