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Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury
Janessa M Graves1, Nithya Kannan, Richard B Mink
11College of Nursing-Spokane, Washington State University, Spokane, WA. 2Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. 3Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 4Department of Pediatrics, Harbor-UCLA and Los Angeles BioMedical Research Institute, Torrance, CA. 5Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. 6Department of Surgery, the Ohio State University College of Medicine, Columbus, OH. 7Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 8Division of Pediatric Neurology, Department of Neurosurgery, Mattel Children's Hospital, UCLA, Los Angeles, CA. 9Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. 10Department of Neurological Surgery, University of Washington, Seattle, WA. 11Department of Global Health Medicine, University of Washington, Seattle, WA. 12Department of Industrial and Systems Engineering, University of Washington, Seattle, WA. 13Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA. 14Department of Epidemiology, University of Washington, Seattle, WA. 15Departments of Pediatrics, University of Washington, Seattle, WA.
Insights
Adherence to pediatric traumatic brain injury guidelines does not increase hospitalization costs. Providing evidence-based care for severe pediatric traumatic brain injury is crucial for patient outcomes, not cost concerns.
Area of Science:
- Pediatric Traumatology
- Health Economics
- Clinical Guideline Implementation
Background:
- Pediatric traumatic brain injury (TBI) guideline adherence improves survival and functional outcomes.
- The economic impact of guideline adherence in pediatric severe TBI has not been previously studied.
Purpose of the Study:
- To evaluate the relationship between adherence to pediatric severe TBI guidelines and total hospitalization costs.
- To determine if guideline adherence influences acute care costs in pediatric TBI patients.
Main Methods:
- Retrospective cohort study involving 235 pediatric patients with severe TBI across five academic pediatric trauma centers.
- Adherence to clinical indicators was measured, and cost-to-charge ratios estimated ICU and total hospital costs.
- Generalized linear models analyzed the association between healthcare costs and adherence rates, adjusting for patient and injury characteristics.
Main Results:
- Estimated mean adjusted hospital costs were $103,485 and adjusted ICU costs were $82,071.
- No significant association was found between guideline adherence and total hospital or ICU costs.
- Cost ratios for hospital and ICU costs were 1.01, indicating no substantial cost increase with adherence.
Conclusions:
- Adherence to severe pediatric TBI guidelines is not associated with increased hospitalization or ICU costs.
- Healthcare costs should not deter institutions from implementing evidence-based care for pediatric severe TBI.
- Focusing on guideline-driven care is essential for optimizing outcomes in pediatric severe TBI patients.
Objectives:
Adherence to pediatric traumatic brain injury guidelines has been associated with improved survival and better functional outcome. However, the relationship between guideline adherence and hospitalization costs has not been examined. To evaluate the relationship between adherence to pediatric severe traumatic brain injury guidelines, measured by acute care clinical indicators, and the total costs of hospitalization associated with severe traumatic brain injury.
Design:
Retrospective cohort study.
Setting:
Five regional pediatric trauma centers affiliated with academic medical centers.
Patients:
Demographic, injury, treatment, and charge data were included for pediatric patients (17 yr) with severe traumatic brain injury.
Interventions:
Percent adherence to clinical indicators was determined for each patient. Cost-to-charge ratios were used to estimate ICU and total hospital costs for each patient. Generalized linear models evaluated the association between healthcare costs and adherence rate.
Measurements And Main Results:
Cost data for 235 patients were examined. Estimated mean adjusted hospital costs were $103,485 (95% CI, 98,553-108,416); adjusted ICU costs were $82,071 (95% CI, 78,559-85,582). No association was found between adherence to guidelines and total hospital or ICU costs, after adjusting for patient and injury characteristics. Adjusted regression model results provided cost ratio equal to 1.01 for hospital and ICU costs (95% CI, 0.99-1.03 and 0.99-1.02, respectively).
Conclusions:
Adherence to severe pediatric traumatic brain injury guidelines at these five leading pediatric trauma centers was not associated with increased hospitalization and ICU costs. Therefore, cost should not be a factor as institutions and providers strive to provide evidence-based guideline driven care of children with severe traumatic brain injury.
