Abstract
Introduction:
Throughout the world, trauma is a leading cause of morbidity and mortality in the young and most active group of society. While specialist trauma centers play a critical role in the survival after severe trauma, the assessment of trauma-related costs, budgeting for adequate trauma capacity, and determining the cost-effectiveness of interventions in critical care are fraught with difficulties. Through a systematic review of the European literature on severe trauma, we aimed to identify the key elements that drive the costs of acute trauma care.
Methods:
A PubMed/MEDLINE search for articles relating the costs and economics of trauma was performed for the period January 1995 to July 2007. One hundred and seventy-three European publications were identified. Twelve publications were retrieved for complete review that provided original cost data, a breakdown of costs according to the different elements of trauma care, and focused on severe adult polytrauma. The identified publications presented studies from the UK (3), Germany (6), Italy (2), and Switzerland (1).
Results:
In all publications reviewed, length of stay in the intensive care unit (ICU; 60%) and requirements for surgical interventions (≤ 25%) were the key drivers of hospital costs. The cost of transfusion during the initial rescue therapy can also be substantial, and in fact represented a significant portion of the overall cost of emergency and ICU care. Multiple injuries often require multiple surgical interventions, and prolonged ICU and hospital stay, and across all studies a clear relationship was observed between the severity of polytrauma injuries observed and overall treatment costs. While significant differences existed in the absolute costs of trauma care across countries, the key drivers of costs were remarkably similar.
Conclusions:
Irrespective of the idiosyncrasies of the national healthcare systems in Europe, severity of injury, length of stay in ICU, surgical interventions and transfusion requirements represent the key drivers of acute trauma care for severe injury.
Similar content being viewed by others
References
Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. World Health Organization, Geneva, 2002.
World Health Organization. The world health report 2003: shaping the future. Geneva: World Health Organization, 2003.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet 1997;349:1269–76.
Fildes J. National trauma data bank. National Trauma Data Bank, 2003.
Chiara O, Scott JD, Cimbanassi S, Marini A, Zoia R, Rodriguez A, Scalea T; Milan Trauma Death Study Group. Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care. Injury 2002;33:553–62.
Centers forDisease Control. Years of potential life lost before age 75 for selected causes of death, Table 30. Health: United States, 2003.
Taheri PA, Butz DA, Lottenberg L, Clawson A, Flint LM. The cost of trauma center readiness. Am J Surg 2004;187:7–13.
Centers for Disease Control and Prevention (CDC). Medical expenditures attributable to injuries–United States, 2000. MMWR Morb Mortal Wkly Rep 2004;53:1–4.
Hansen KS, Morild I, Engesæter LB, Viste A. Epidemiology of severely and fatally injured patients in western part of Norway. Scand J Surg 2004;93:198–203.
Di Bartolomeo S, Sanson G, Michelutto V, Nardi G, Burba I, Francescutti C, Lattuada L, Scian F. Epidemiology ofmajor injury in the population of Friuli Venezia Giulia-Italy. Injury 2004;35:391–400.
Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and lifetime costs of injuries in the United States. Inj Prev 2006;12:212–8.
Pape HC, Oestern HJ, Leenen L, Yates DW, Stalp M, Grimme K, Tscherne H, Krettek C. Documentation of blunt trauma in Europe. Eur J Trauma 2000;26:233–47.
Boldt J. Can we afford the costs of progress in intensive care medicine? A plea for a candid debate [in German]. Dtsch Med Wochenschr 2004;129:36–40.
Pastores SM, Halpern NA. Acquisition strategies for critical care technology. Crit Care Clin 2000;16:545–56.
Morris S, Ridley S, Munro V, Christensen MC. Cost effectiveness of recombinant activated factor VII for the control of bleeding in patients with severe blunt trauma injuries in the United Kingdom. Anaesthesia 2007;62:43–52.
Pape HC, Grotz M, Schwermann T, Ruchholtz S, Lefering R, Rieger M, Tröger M, von der Graf Schulenburg JM, Krettek C. The development of a model to calculate the cost of care for the severely injured — an initiative of the Trauma Register of the DGU [in German]. Unfallchirurg 2003;106:348–57.
Chiara O, Cimbanassi S. Organized trauma care: does volume matter and do trauma centers save lives?. Curr Opin Crit Care 2003;9:510–4.
Taheri PA, Butz DA, Watts CM, Griffes LC, Greenfield LJ. Trauma services: a profit center? J Am Coll Surg 1999;188:349–54.
Westhoff J, Hildebrand F, Grotz M, Richter M, Pape HC, Krettek C. Trauma care in Germany. Injury 2003;34:674–83.
Rossi C, Simini B, Brazzi L, Rossi G, Radrizzani D, Iapichino G, Bertolini G. Variable costs of ICU patients: a multicenter prospective study. Intensive Care Med 2006;32:545–52.
Iapichino G, Radrizzani F, Simini B, Rossi C, Albicini M, Ferla L, Colombo A, Pezzi A, Brazzi L, Melotti R, Rossi G. Effectiveness and efficiency of intensive care medicine: variable costs in different diagnosis groups. Acta Anaesthesiol Scand 2004;48:820–6.
Obertacke U, Neudeck F, Wihs HJ, Schmit-Neuerburg KP. Emergency care and treatment costs of polytrauma patients [in German]. Langenbecks Arch Chir Suppl Kongressbd 1996;113:641–5.
Sikand M, Williams K, White C, Moran CG. The financial cost of treating polytrauma: implications for tertiary referral centers in the United Kingdom. Injury 2005;36:733–7.
Cowey A, Mitchell P, Gregory J, Maclennan I, Pearson R. A review of 187 gunshot wound admissions to a teaching hospital over a 54-month period: training and service implications. Ann R Coll Surg Engl 2004;86:104–7.
Rösch M, Klose T, Leidl R, Gebhard F, Kinzl L, Ebinger T. Cost analysis of the treatment of patients with multiple trauma [in German]. Unfallchirurg 2000;103:632–9.
Schmelz A, Ziegler D, Beck A, Kinzl L, Gebhard F. Costs for acute, stationary treatment of polytrauma patients [in German]. Unfallchirurg 2002;105:1043–8.
Schwermann T, Grotz M, Blanke M, Ruchholtz S, Lefering R, Graf VD, Schuelenburg JM, Krettek C, Pape HC. Evaluation of costs incurred for patients with multiple trauma particularly from the perspective of the hospital [in German]. Unfallchirurg 2004;107:563–74.
Grotz M, Schwermann T, Lefering R, Ruchholtz S, Graf v d Schulenburg JM, Krettek C, Pape HC. DRG reimbursement for multiple trauma patients — a comparison with the comprehensive hospital costs using the German trauma registry [in German]. Unfallchirurg 2004;107:68–75.
Flohe S, Buschmann C, Nabring J, Merquet P, Luetkes P, Lefering R, Nast-Kolb D, Ruchholtz S. Definition of polytrauma in the German DRG system 2006. Up to 30% “incorrect classifications” [in German]. Unfallchirurg 2007;110:651–8.
Ganzoni D, Zellweger R, Trentz O. Cost analysis of acute therapy of polytrauma patients [in German]. Swiss Surg 2003;9:268–74.
Maraste P, Persson U, Berntman M. Long-term follow-up and consequences for severe road traffic injuries-treatment costs and health impairment in Sweden in the 1960s and the 1990s. Health Policy 2003;66:147–58.
Lindqvist KS, Brodin H. One-year economic consequences of accidents in a Swedish municipality. Accid Anal Prev 1996;28:209–19.
Kurola J, Wangel M, Uusaro A, Ruokonen E. Paramedic helicopter emergency service in rural Finland — do benefits justify the cost? Acta Anaesthesiol Scand 2002;46:779–84.
Shorr AF. An update on cost-effectiveness analysis in critical care. Curr Opin Crit Care 2002;8:337–43.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pape, HC., Neugebauer, E., Ridley, S.A. et al. Cost-Drivers in Acute Treatment of Severe Trauma in Europe: A Systematic Review of Literature. Eur J Trauma Emerg Surg 35, 61–66 (2009). https://doi.org/10.1007/s00068-008-8013-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-008-8013-0