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Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury*

Graves, Janessa M. PhD, MPH; Kannan, Nithya MD; Mink, Richard B. MD, MACM; Wainwright, Mark S. MD, PhD; Groner, Jonathan I. MD; Bell, Michael J. MD; Giza, Christopher C. MD; Zatzick, Douglas F. MD; Ellenbogen, Richard G. MD; Boyle, Linda Ng PhD; Mitchell, Pamela H. PhD; Rivara, Frederick P. MD, MPH; Wang, Jin PhD; Rowhani-Rahbar, Ali MD, PhD; Vavilala, Monica S. MD

Pediatric Critical Care Medicine: May 2016 - Volume 17 - Issue 5 - p 438–443
doi: 10.1097/PCC.0000000000000698
Neurocritical Care
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Objectives: Adherence to pediatric traumatic brain injury guidelines has been associated with improved survival and better functional outcome. However, the relationship between guideline adherence and hospitalization costs has not been examined. To evaluate the relationship between adherence to pediatric severe traumatic brain injury guidelines, measured by acute care clinical indicators, and the total costs of hospitalization associated with severe traumatic brain injury.

Design: Retrospective cohort study.

Setting: Five regional pediatric trauma centers affiliated with academic medical centers.

Patients: Demographic, injury, treatment, and charge data were included for pediatric patients (17 yr) with severe traumatic brain injury.

Interventions: Percent adherence to clinical indicators was determined for each patient. Cost-to-charge ratios were used to estimate ICU and total hospital costs for each patient. Generalized linear models evaluated the association between healthcare costs and adherence rate.

Measurements and Main Results: Cost data for 235 patients were examined. Estimated mean adjusted hospital costs were $103,485 (95% CI, 98,553–108,416); adjusted ICU costs were $82,071 (95% CI, 78,559–85,582). No association was found between adherence to guidelines and total hospital or ICU costs, after adjusting for patient and injury characteristics. Adjusted regression model results provided cost ratio equal to 1.01 for hospital and ICU costs (95% CI, 0.99–1.03 and 0.99–1.02, respectively).

Conclusions: Adherence to severe pediatric traumatic brain injury guidelines at these five leading pediatric trauma centers was not associated with increased hospitalization and ICU costs. Therefore, cost should not be a factor as institutions and providers strive to provide evidence-based guideline driven care of children with severe traumatic brain injury.

Supplemental Digital Content is available in the text.

1College of Nursing-Spokane, Washington State University, Spokane, WA.

2Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.

3Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

4Department of Pediatrics, Harbor-UCLA and Los Angeles BioMedical Research Institute, Torrance, CA.

5Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.

6Department of Surgery, the Ohio State University College of Medicine, Columbus, OH.

7Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

8Division of Pediatric Neurology, Department of Neurosurgery, Mattel Children’s Hospital, UCLA, Los Angeles, CA.

9Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.

10Department of Neurological Surgery, University of Washington, Seattle, WA.

11Department of Global Health Medicine, University of Washington, Seattle, WA.

12Department of Industrial and Systems Engineering, University of Washington, Seattle, WA.

13Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA.

14Department of Epidemiology, University of Washington, Seattle, WA.

15Departments of Pediatrics, University of Washington, Seattle, WA.

*See also p. 467.

The work was performed at the College of Nursing-Spokane, Washington State University.

The study was conceived by Drs. Graves and Vavilala. Dr. Graves led the analysis, interpretation, and initial drafting of the article. Dr. Graves had full access to all cost data and takes responsibility for its integrity of the data and the accuracy of the data analysis. All authors read, provided feedback on, and approved all article drafts.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Graves received support for article research from the National Institutes of Health (NIH). Her institution received grant support from the NIH/NINDS (The source of support for this work including design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript was NINDS R01 NS072308-03). Drs. Kannan, Wainwright, Groner, Bell, Zatzick, Boyle, Mitchell, Wang, Rowhani-Rahbar, and Vavilala received support for article research from the NIH. Drs. Kannan, Wainwright, Groner, Bell, Zatzick, Boyle, Mitchell, Wang, Rowhani-Rahbar, and Vavilala and their institutions received grant support from the NIH. Dr. Mink served as a board member for the American Board of Pediatrics (Received honorarium as a member of the Education and Training Committee) and received support for article research from the NIH. Dr. Mink and his institution received grant support from the NIH. His institution received grant support from the NIH (Subcontract with UCLA). Dr. Giza consulted for the NCAA, Major League Soccer, U.S. Soccer Federation (Travel reimbursement for attendance at meetings); Pearson PLC (One-time consultation); and Alcobra (One-time consultation). He lectured for Medical Education Speakers Network, individual institutions (Honoraria for 1-3 medical or educational lectures per month related to pediatric neurology), received royalties from Blackwell Publishing (Royalties from Neurological Differential Diagnosis: A Prioritized Approach book), and received support for article research from the NIH. Dr. Giza and his institution received grant support from the NIH. His institution provided expert testimony for Medicolegal cases (one or two cases annually) and received grant support from NCAA-DOD, Joseph Drown Foundation, UCLA Steve Tisch BrainSPORT Program, NFL-GE, DARPA (Multiple research grants from both public and private funding sources). Dr. Ellenbogen received grant support from the NIH/NCI and received support for article research from the NIH. Dr. Ellenbogen and his institution received grant support from the NIH. Dr. Rivara received support for article research from the NIH. His institution received grant support from the NIH. Dr. Vavilala received support for this article research form National Institute of Neurological Disorders and Stroke (R01 NS072308-03).

Address requests for reprints to: Janessa M. Graves, PhD, MPH, College of Nursing-Spokane, Washington State University, Spokane, WA 99202. E-mail: janessa.graves@wsu.edu

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies