OBJECTIVES: To generate national estimates of inpatient costs, length of stay (LOS), and probability of death in US hospitalizations for blunt or penetrating trauma, stratified by injury severity and trauma center designation of the admitting facility.
METHODS: Discharge data from the 2002 HCUP Nationwide Inpatient Sample were analyzed for 596,762 hospitalizations (unweighted n = 122,706) for blunt or penetrating trauma. An injury severity score (ISS) was calculated for each admission using the ICDMAP90 software package; mutually exclusive categories corresponding to increasing injury severity were identified. Data on admitting facilities’ trauma center designation were obtained from the American Hospital Association. Stays for patients either admitted from, or transferred to, another inpatient facility were excluded. Weighted estimates of costs, LOS, and probability of death were calculated for each stay.
RESULTS: Most admissions (64.3%) were for low severity injuries (ISS = 0–9); critical injuries (ISS = 25+) represented 6.4% of admissions. More than half (54.5%) of all admissions were to non-trauma centers; Level I, II, and III/IV trauma centers represented 20.5%, 20.2%, and 4.1% of admissions, respectively. Overall, inpatient costs increased substantially with injury severity, ranging from $8806 for low severity admissions to $40,255 for critical admissions. LOS and probability of death also increased from low to critical injury severity (5.2 to 13.2 days, 2.4% to 28.3%, respectively). Costs, LOS, and probability of death decreased from Level I to III/IV trauma centers ($18,696 to $5924, 7.0 to 4.7 days, 5.7% to 3.2%, respectively); for non-trauma centers, these outcomes were $11,411, 6.4 days, and 4.4%, respectively.
CONCLUSION: This is one of the first studies to quantify differences in inpatient costs and outcomes for traumatic injury across varying levels of injury severity and trauma center designation, in a multi-payer US population. Substantial variation within these characteristics was observed for all outcomes evaluated. Providers, payers, and other decision makers should be aware of these differences.
