title: Trauma patients return to productivity.
abstract: Economic issues threaten the development of a national trauma system. Much work has focused on the cost of trauma care; little has been done to define society's long-term economic return. We asked three questions about high cost trauma patients: (1) Do they survive?, (2) Do they continue to require expensive care?, and (3) Do they return to productivity? Of 6,129 consecutive trauma admissions, 114 had hospital charges over $100,000 (mean = $143,000), 102 (89.5%) were discharged alive, and 10 (8.8%) were lost to followup. Ninety-two patients or families were interviewed at least 1 year (mean = 2.6 year) after discharge. There were 88 survivors and 4 deaths (3.5%). Of the 88 survivors 73% had no limitation of ADLs, 67% received rehabilitation, 58% were still improving, and 37% were involved in litigation. Five survivors (5.7%) were confined to a nursing home, 48 (54.5%) had returned to productivity (RTP), 35 (39.8%) were unemployed, and five of these still require medical therapy. We conclude: (1) The majority of high cost patients survive (89.5%) and return to productivity (54.5%); (2) the severity of injury predicts survival but not return to productivity; and (3) the RTP rate may be increased by addressing nonmedical need.
authors.affiliation: Division of Trauma, Vanderbilt University School of Medicine, Nashville, TN 37212.
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: A A
authors.initials: AA
authors.lastname: Sanchez
authors.forename: S M
authors.initials: SM
authors.lastname: Bass
authors.forename: E J
authors.initials: EJ
authors.lastname: MacKenzie
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004493:Education; D004651:Employment; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015601:Injury Severity Score; D008875:Middle Aged; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care; D014481:United States; D014947:Wounds and Injuries / Q000191:economics*