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Trauma center performance evaluation based on costs: A systematic review of cohort studies

Porgo, Teegwendé Valérie MSc; Shemilt, Michèle MSc; Moore, Lynne PhD; Bourgeois, Gilles MD; Lapointe, Jean MD

Journal of Trauma and Acute Care Surgery: February 2014 - Volume 76 - Issue 2 - p 542–548
doi: 10.1097/TA.0b013e3182ab0dc8
Review Articles

BACKGROUND: In 2000, more than 50 million Americans were treated in hospitals following injury, with costs estimated at $80 billion, yet no performance indicator based on costs has been developed and validated specifically for acute trauma care. This study aimed to describe how data on costs have been used to evaluate the performance of acute trauma care hospitals.

METHODS: A systematic review using MEDLINE, EMBASE, Web of Science, The Cochrane Library, CINAHL, TRIP, and ProQuest was performed in December 2012. Cohort studies evaluating hospital performance for the treatment of injury inpatients in terms of costs were considered eligible. Two authors conducted the screening and the data abstraction independently using a piloted electronic data abstraction form. Methodological quality was evaluated using seven criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Downs and Black tool.

RESULTS: The search retrieved 6,635 studies, of which 10 were eligible for inclusion. Nine studies were conducted in the United States and one in Europe. Six studies used patient charges as a proxy for patient costs, of which four used cost-to-charge ratios. One study estimated costs using average unit costs, and three studies were based on the real costs obtained from a hospital accounting system. Average costs per patient in 2013 US dollar varied between 2,568 and 74,435. Four studies (40%) were considered to be of good methodological quality.

CONCLUSION: Studies evaluating the performance of trauma hospitals in terms of costs are rare. Most are based on charges rather than costs, and they have low methodological quality. Further research is needed to develop and validate a performance indicator based on inpatient costs that will enable us to monitor trauma centers in terms of resource use.

LEVEL OF EVIDENCE: Systematic review, evidence, level III.

From the Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs) (T.V.P., M.S., L.M.), Centre de Recherche du CHU de Québec - Hôpital de l’Enfant-Jésus, Université Laval, Québec City; Department of Social And Preventative Medicine (T.V.P., M.S., L.M.), Université Laval; Institut national d’excellence en santé et en services sociaux (G.B., J.L.), Montreal, Quebec, Canada.

Submitted: September 11, 2013, Revised: September 30, 2013, Accepted: September 30, 2013.

This study was presented in part at the Trauma Association of Canada meeting, April 2013, in Whistler, British Columbia.

Address for reprints: Lynne Moore, PhD, Axe Santé des populations et pratiques optimales en santé, (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l’Enfant-Jésus, 1401, 18eme rue, Quebec City, Quebec, Canada, G1J 1Z4; email:

© 2014 Lippincott Williams & Wilkins, Inc.