Risk factors and economic impact of long-term nursing care after major trauma

The public could bear a heavy economic burden for trauma survivors needing long-term nursing care, especially in countries such as Taiwan that have universal health insurance coverage. The purpose of this study was to analyze the data from the National Health Insurance Research Database and to assess reimbursement to trauma patients with long-term sequelae who need nursing care.

This study included all patients who suffered major trauma (injury severity score ≥ 16) in Taiwan from 2003 to 2007. Ten years of follow-up were analyzed. Patients aged 18 to 70 who survived for more than 1 year after the index admission were enrolled. Patients who needed long-term nursing care (LTC) were compared with those who did not (non-LTC). Basic demographics and short-term outcomes were analyzed, and the 10-year healthcare expenditure was calculated.

The study included 10,642 patients, 1,718 in the LTC group and 8,924 in the non-LTC group. Age, comorbidities, spinal cord injury, longer mechanical ventilation, longer ICU length of stay (LOS), and longer hospital LOS were identified as independent risk factors for LTC. The median 10-year healthcare expenditure was 43,979 USD in the LTC group vs. 9,057 USD in the non-LTC group (p < 0.001).

16.14% of major trauma patients needed LTC at least 1 year after being discharged. The resource they receive in Taiwan is prominently less than the same patient group in the US. The NHI should invest more in post-discharge care for major trauma patients to optimize their care.