Research Reports - The financial outcome of traumatic brain injury
Br J Neurosurg. 2016 Oct 22:1-6. [Epub ahead of print]
Fountain DM(1), Kolias AG(1), Laing RJ(1), Hutchinson PJ(1).
OBJECTIVES: Severe traumatic brain injury (TBI) is a potentially devastating
insult to the brain with high rates of fatality and neurological deficits. TBI
can result in substantial costs to the centre providing care. We sought to
present the experience of a Major Trauma Centre (MTC) and ascertain the financial
implications of this healthcare provision, in particular detailed costs,
reimbursement and the surplus or deficit accrued by the centre.
DESIGN: All cranial non-elective neurosurgical admissions with a TBI over 4.5
months (26 October 2014 to 15 March 2015) were analysed retrospectively,
excluding cases of chronic subdural haematoma, at an MTC in England. Demographic
data were collected alongside detailed cost and income data.
RESULTS: Ninety four patients were identified. The majority of patients presented
with more than one diagnosis of cranial trauma. Average length of stay was
18.8 ± 21.6 days. Total deficits as a result of treating this cohort amounted to
£558,034. There was a significant association between (i) more complex
presentations and (ii) a longer length of stay and the deficit accrued by the
centre. The major drivers of the financial outcome were costs associated with
wards, medical staffing and overheads.
CONCLUSION: There was a substantial deficit accrued as a result of the management
of patients with TBI at an MTC. The more complex the presentation, extensive the
intervention, and lengthy the stay, the greater the deficit accrued by the
centre. The current tariff payment system is not effectively reflecting the
severity of injury or intensity of management of patients with TBI.