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Observational Study
. 2020 Jul;162(7):1607-1618.
doi: 10.1007/s00701-020-04384-9. Epub 2020 May 14.

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

Jeroen T J M van Dijck  1   2 , Cassidy Q B Mostert  3 , Alexander P A Greeven  4 , Erwin J O Kompanje  5   6 , Wilco C Peul  3 , Godard C W de Ruiter  3 , Suzanne Polinder  7
Affiliations
Observational Study

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

Jeroen T J M van Dijck et al. Acta Neurochir (Wien). 2020 Jul.

Abstract

Background: The high occurrence and acute and chronic sequelae of traumatic brain injury (TBI) cause major healthcare and socioeconomic challenges. This study aimed to describe outcome, in-hospital healthcare consumption and in-hospital costs of patients with TBI.

Methods: We used data from hospitalised TBI patients that were included in the prospective observational CENTER-TBI study in three Dutch Level I Trauma Centres from 2015 to 2017. Clinical data was completed with data on in-hospital healthcare consumption and costs. TBI severity was classified using the Glasgow Coma Score (GCS). Patient outcome was measured by in-hospital mortality and Glasgow Outcome Score-Extended (GOSE) at 6 months. In-hospital costs were calculated following the Dutch guidelines for cost calculation.

Results: A total of 486 TBI patients were included. Mean age was 56.1 ± 22.4 years and mean GCS was 12.7 ± 3.8. Six-month mortality (4.2%-66.7%), unfavourable outcome (GOSE ≤ 4) (14.6%-80.4%) and full recovery (GOSE = 8) (32.5%-5.9%) rates varied from patients with mild TBI (GCS13-15) to very severe TBI (GCS3-5). Length of stay (8 ± 13 days) and in-hospital costs (€11,920) were substantial and increased with higher TBI severity, presence of intracranial abnormalities, extracranial injury and surgical intervention. Costs were primarily driven by admission (66%) and surgery (13%).

Conclusion: In-hospital mortality and unfavourable outcome rates were rather high, but many patients also achieved full recovery. Hospitalised TBI patients show substantial in-hospital healthcare consumption and costs, even in patients with mild TBI. Because these costs are likely to be an underestimation of the actual total costs, more research is required to investigate the actual costs-effectiveness of TBI care.

Keywords: Functional outcome; In-hospital costs; Mortality; Traumatic brain injury.

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Conflict of interest statement

The authors declare they have no conflict of interest.

Figures

Fig. 1
Fig. 1
In-hospital mortality and functional outcome (favourable GOSE 5–8, unfavourable GOSE 1–4) at 6 month follow-up for patients with TBI in different severities
Fig. 2
Fig. 2
The mean in-hospital costs for patients with TBI, specified per severity category and per cost category to show their contribution to the total in-hospital costs
See this image and copyright information in PMC

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