One-year costs of intensive care in pediatric patients with traumatic brain injury

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  • 1 Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden, and University of Helsinki;
  • 2 Department of Emergency Care and Services, Helsinki University Hospital, and University of Helsinki;
  • 3 Department of Anesthesiology and Intensive Care, Kuopio University Hospital, and University of Eastern Finland, Kuopio;
  • 4 Department of Intensive Care, Turku University Hospital, and University of Turku;
  • 5 Emergency Medical Services and Department of Intensive Care, Tampere University Hospital, and Tampere University, Tampere;
  • 6 Division of Intensive Care, Medical Research Center Oulu, Oulu University Hospital, Research Group of Anesthesiology, Surgery and Intensive Care Medicine, University of Oulu; and
  • 7 Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Finland
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OBJECTIVE

Traumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.

METHODS

In this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).

RESULTS

In total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.

CONCLUSIONS

Greater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

ABBREVIATIONS ECPFO = effective cost per favorable outcome; ECPS = effective cost per survivor; FICC = Finnish Intensive Care Consortium; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury; VIF = variance inflation factor.

Supplementary Materials

    • Supplemental Digital Content (PDF 467 KB)

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Contributor Notes

Correspondence Era D. Mikkonen: Karolinska University Hospital, Stockholm, Sweden, and University of Helsinki, Finland. era.mikkonen@helsinki.fi.

INCLUDE WHEN CITING Published online October 16, 2020; DOI: 10.3171/2020.6.PEDS20189.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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