OBJECTIVES: To generate national estimates of inpatient costs, length of stay (LOS), and probability of death among US pediatric (=17 years) hospitalizations for blunt or penetrating trauma, stratified by injury severity and trauma center designation of the admitting facility.
METHODS: Discharge data from the 2002 HCUP Nationwide Inpatient Sample were analyzed for 55,561 pediatric hospital admissions (unweighted n=11,566) for blunt or penetrating trauma. An injury severity score (ISS) was calculated for each admission using the ICDMAP90 software; 4 mutually exclusive categories corresponding to increasing severity were identified. Data on admitting facilities'' trauma center designation were obtained from the American Hospital Association. Stays for patients admitted from or transferred to another inpatient facility were excluded. Weighted estimates of costs, LOS, and probability of death were calculated for each stay.
RESULTS: Most admissions (57.5%) were for low severity injuries (ISS=0-9); critical injuries (ISS=25+) represented 8.5% of admissions. Nearly half (44.9%) of all admissions were to non-trauma centers; Level I, II, and III/IV trauma centers represented 29.9%, 19.5%, and 4.3% of admissions, respectively. Overall, inpatient costs increased substantially with injury severity, ranging from $7,803 for low severity admissions to $34,135 for critical admissions. LOS and probability of death also increased from low to critical injury severity (3.0 to 10.7 days, 0.5% to 23.9%, respectively). Costs, LOS, and probability of death decreased from Level I to III/IV trauma centers ($14,745 to $9,170, 5.1 to 3.6 days, 3.3% to 2.9%, respectively); for non-trauma centers, these outcomes were $12,267, 4.6 days, and 2.6%, respectively.
CONCLUSION: This is one of few studies to quantify differences in inpatient costs and outcomes for traumatic injury among pediatric patients across levels of injury severity and trauma center designation, in a multi-payer US population. Substantial variation was observed for all outcomes evaluated. These results may help decision makers allocate resources appropriately.
