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Longitudinal Analysis of Hospital Charges Following Injury in a Level 1 Pediatric Trauma System
Sean M. Stokes, Eric R. Scaife, Austin M. Stevens, Stephen J. Fenton. Univeristy of Utah School of Medicine, Salt Lake City, UT, USA.

Background: The treatment of injured children contributes substantially to the financial burden of a health care system. The purpose of this study was to characterize these charges at a level 1 pediatric trauma center.

Methods: Financial data for children (<14 years) admitted for traumatic injury from January 2009 to December 2014 were analyzed. The charges of the index admission, and during the first two years following discharge, were evaluated. Trauma patients were further subdivided based on injury pattern.

Results: 5,852 trauma patients were included with average annual charges of $11,128,730. In comparison, the average annual charges of children undergoing appendectomy during this period were $4,234,429. The most common mechanism of injury was fall (44%), followed by sports (12%), and bike (9%). The median injury severity score was 9 (range 1-75) with a mortality rate of 1.7% and Z score of 13.04 (p<0.001). The overall total charges per patient during the index admission were $9,508. Spinal cord and major abdominal injuries had the greatest charges per patient ($55,560 and $23,618 respectively) primarily due to hospital length of stay. During the first year after discharge: the total charges per patient were $1,733, of which spinal cords resulted in highest overall charges ($19,426), primarily due to inpatient rehabilitation. For all other injury patterns, mean total charges per patient were $2,376 (range $791-$3573).

Conclusions: The value proposition in health care requires us to define outcomes relative to costs. This study seeks to understand the financial impact of providing pediatric trauma care.

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