Pediatric Trauma Society

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Hospital-level Variation in Cost of Pediatric Trauma Care
*Robert A Tessler1, Janessa M. Graves2, Monica S. Vavilala1, Adam Goldin3, *Frederick P. Rivara1
1Harborview Injury Prevention and Research Center, Seattle, WA;2Washington State University College of Nursing, Spokan, WA;3Seattle Children's Hospital, Department of Surgery, Seattle, WA

Background (issue):Variations in practice may lead to unnecessary hospital expenditure in pediatric trauma. Data on hospital-level variation in the cost of care for pediatric trauma patients is limited.
Methods:The 2012 Health Care and Utilization Project Kidís Inpatient Database (HCUP-KID) was queried for hospitalizations for common trauma admissions for patients aged <18 years: long bone fracture, traumatic brain injury, blunt abdominal trauma, and poly trauma (more than one injury diagnosis). After grouping by injury and injury severity, we assessed cost variation by calculating median hospital costs, inter-quartile range (IQR), and width of the interquartile range (WIQR) based on hospital charges and hospital-specific cost-to-charge ratios.
Findings:In 2012, 58,630 injured children met inclusion criteria at 2,120 hospitals in the HCUP-KID, of which 57.3% were TBI, 31.5% long bone fracture and 11.2% were blunt abdominal trauma. Median cost per patient stay was $6,200 (WIQR: $5,745, IQR: 3,979-9,723). Cost variation at the hospital level was greatest for critical/unsurvivable TBI (WIQR: $50,448 median: $30,395), polytrauma (WIQR:$30,440, median:$27,667) and high-grade blunt abdominal trauma (WIQR:$21,787, median:$18,470). Cost variation was lowest for humerus fracture (WIQR $4,754, median: $5,322) and minor TBI (WIQR $4,789, median: $4,600).
Conclusions (implications for practice): This cost variation represents very different resource utilization in caring for similar patients. In order to achieve the Triple Aim, processes of care will need to be improved to achieve similar outcomes at lower cost.


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