93.20 Outcomes and Costs of Patients Admitted with Isolated Blunt Intracranial Hemorrhage

Posted on January 31, 2019

B. N. Cragun1, M. R. Noorbakhsh1, F. Hite Philp1, A. S. Philp1  1Allegheny General Hospital,Division Of Trauma Surgery,Pittsburgh, PA, USA

Introduction: Blunt traumatic intracranial hemorrhage (ICH) is associated with significant morbidity and mortality.  The management of these patients often includes ICU admission, neurosurgery consultation, and interval imaging.  While the outcomes for these patients are well established, less is known regarding the costs incurred.  We evaluated this patient population in order to identify outcomes and cost patterns.

Methods:  We retrospectively identified patients admitted to a single level 1 trauma center with isolated blunt ICH from February 2016 to August 2017.  We conducted chart reviews and obtained cost and payment information from the hospital finance department.

Results: We identified 556 patients in our 20 month study period, with a mortality of 12.6%.  ICH was associated with a mean total cost of index hospitalization of $13,820.  Mean cost per survivor was $15,811.  Decedents were significantly costlier than survivors ($18,100 vs $13,224, p=0.001).  Patients admitted to the ICU had a significantly higher mean total cost than patients admitted to the floor ($15,734 vs $4,692, p<0.001), and higher mean cost per day ($3,144 vs $2,192, p=0.02).  Traumatic ICH associated with oral anticoagulant use had a mean total cost of $16,638, compared with $13,969 in patients not on anticoagulants (p=0.05).  Mean total cost was significantly higher for patients that required neurosurgical intervention ($42,289 vs $10,821, p<0.001).  

Conclusion: Patients admitted to the hospital after traumatic ICH require costly care and have high mortality, leading to elevated cost per survivor.  Patients admitted to the ICU incur greater costs than patients admitted to the floor.  Traumatic ICH is particularly costly for patients who require neurosurgical intervention and for those taking oral anticoagulant medications.  Our findings provide information regarding the financial impact of this common traumatic injury.