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Grant E. O'Keefe, MD; Ronald V. Maier, MD; Paula Diehr, PhD; David Grossman, MD, MPH; Gregory J. Jurkovich, MD; Douglas Conrad, PhD

Arch Surg. 1997;132(8):920-924.

Abstract
Objectives
To estimate the expected costs for acute trauma care, to quantify the costs associated with the development of complications in injury victims, and to determine the deficit incurred by patients in whom complications develop.

Design
A retrospective, cohort design.

Setting
A referral trauma center.

Patients
A total of 12 088 patients admitted to a single regional trauma center during a period of 5 years.

Interventions
This is an observational study, and no interventions specific 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 complications of trauma. (3) The effect of complications on inadequate reimbursement 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 $14 567, and the observed costs averaged $15 032. Six complications were important predictors of cost. These included adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23 266 and the observed costs averaged $47 457. The mean excess costs for a single complication ranged from $6669 to $18 052. Multiple complications led to greater increases in excess cost, averaging $110 007 for the 62 patients with 3 or more complications. Costs exceeded 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 associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.

Arch Surg. 1997;132:920-924

Author Affiliations
From the Departments of Surgery (Drs O'Keefe, Maier, and Jurkovich), Health Services (Drs Diehr, Grossman, and Conrad), and Pediatrics (Dr Grossman), and the Harborview Injury Prevention Research Center (Drs O'Keefe, Maier, Grossman, Jurkovich, and Conrad), University of Washington, Seattle.

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