A. D. Melucci1, B. Lang1, V. Dombrovskiy1, J. Pierre1, Y. Lee1 1Rutgers Robert Wood Johnson,New Brunswick, NJ, USA
Introduction: Restraint quality may have a significant impact on injury severity in children after motor vehicle crashes (MVCs). The aim of this study is to analyze if restraint quality and injury severity affect total hospital cost.
Methods: A retrospective chart and financial record review of 421 children hospitalized in a Pediatric Trauma Center in 2010-2015 after MVC and discharged alive was performed. Because of abnormal distribution, we presented total hospital cost in dollars as a median with interquartile range and compared it between various groups with Wilcoxon rank-sum test. All costs were adjusted by inflation to the cost in the year 2015.
Results: To evaluate the predictors of greater cost, we performed subgroup analysis by age groups (0-7, 8-12, 13-16, 17-18 years), gender, restraint status (improper and unrestrained [IUR] and properly restrained [PR]), and injury severity score (ISS) classes (mild [1-9], moderate [10-15], severe [16-25], and profound [>25]). There were no significant differences in total hospital cost between various age groups. Females (n=228) predominated over males (n=193) in the study population and tended to have a higher cost compared to their male counterparts [5230 (3236-11189) and 4829 (3140-8193); P=0.08]. Total hospital cost was significantly higher in IUR compared to PR counterparts [5400 (3413-10954) and 4738 (3128-9105), respectively; P=0.03]. IUR compared to PR had a smaller proportion of children in the mild ISS class (70.3% vs 81.4%; P=0.01), but significantly greater proportions of IUR to PR in the moderate (15.9% vs 10.9%), severe (8.0% vs 6.2%) and profound (5.8% vs 1.5%) classes. The great differences in cost were found between various ISS classes: the higher the ISS, the greater associated total cost. Total cost was minimal in the mild class (3723 [3048-6178], but gradually and significantly increased in the moderate (12456 [7028-21173]; P<0.0001) and severe (18579 [12776-32572]; P=0.01) classes and became maximal in the profound class (43414 [30424-58203]; P=0.004). Overall in the study population, total hospital cost positively correlated with the ISS score (r=0.63; P<0.0001).
Conclusion: Inappropriate restraint significantly increases total hospital cost in children after MVCs proportionally to the injury severity.
