gms | German Medical Science

Objectives: Severe traumatic brain injury (TBI) is a potentially devastating insult to the brain with high rates of fatality and neurological deficits. Evidence suggests TBI can result in substantial costs to the centre providing care, but there is an absence of data on financial outcome. We sought to present the experience of a Major Trauma Centre (MTC) in the United Kingdom and ascertain the financial implications of this healthcare provision, in particular detailed costs, reimbursement and the surplus or deficit accrued by the centre.

Methods: All cranial non-elective neurosurgical admissions with a TBI over 4.5 months (26^th October 2014 to 15^th March 2015) were analysed retrospectively, excluding cases of chronic subdural haematoma, at an MTC in England. Clinical and demographic data were collected alongside detailed cost and income data.

Results: Ninety-four patients were identified. The majority of patients presented with more than one diagnosis of cranial trauma. Average length of stay was 18.8±21.6 days. Total deficits as a result of treating this cohort amounted to £558,034. There was a significant association between (i) more complex presentations and (ii) a longer length of stay and the deficit accrued by the centre. The major drivers of the financial outcome were costs associated with wards, medical staffing and overheads.

Conclusion: There was a substantial deficit accrued as a result of the management of patients with TBI at an MTC. The more complex the presentation, extensive the intervention, and lengthy the stay, the greater the deficit accrued by the centre. The tariff payment system in the United Kingdom is not currently effectively reflecting the severity of injury or intensity of management of patients with TBI.