Research Reports - Trends in outcomes and hospitalization costs among traumatic brain injury in adult patients in the United States

J Neurotrauma. 2012 Sep 14

Souayah N, Khosro F, Khan HM, Ji AB, Yacoub HA, Qureshi AI

Introduction: Several new therapeutic strategies have been introduced for the
management of adult traumatic brain injury (TBI) over the last decade such as the
development of management pathways and specialized TBI units and improved
treatment of cerebral perfusion. The purpose of this study is to compare
TBI-related hospitalization outcomes in the United States between two time
periods, 1993-1994 and 2006-2007. Materials and Methods: We determined the rates
of occurrence, in-hospital outcomes, and mean hospital charges for patients
hospitalized with adult TBI in 1993-1994 using the nationally representative all
payer Nationwide Inpatient Survey (NIS) database and compared these outcomes with
homologous data from 2006-2007. Results: The incidence of TBI admissions was
reduced by 35% in 2006-2007 compared to 1993-1994; (22/100,000 versus 34/100,000
population; p< 0.0001). The mean length of hospitalization in days (mean ± SD, in
days) was significantly lower in 2006-2007 compared to1993-1994 (2.5 ± 2.4 versus
2.7 ± 2.6; p<0.0001). In-hospital mortality increased significantly in 2006-2007
compared with 1993-1994 (0.8% versus 0.4%, p<0.0001). The average hospitalization
charges was significantly higher in 2006-2007 compared to 19993-1994 ($21,460 ±
$21,212 versus $5,142 ± $4,625; p<0.0001), even after adjusting for inflation. In
both time periods, most hospitalized adult TBI patients were graded as mild
injury (98.2% in 1993-1994 versus 98.0% in 2006-2007; p=0.20). There was a
significant increase of average hospitalization charges and death rates in all
TBI severity subgroups in 2006-2007 compared to that of 1993-1994. Conclusion:
The decline in the rate of hospitalization between the two time periods was
predominantly related to the decline in the number of admissions of patients with
mild TBI. Although the number of TBI admissions was reduced, a significant
increase in average hospitalization charges and in-hospital mortality rate was
observed in 2006-2007 compared with 1993-1994.


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