Cost factors in pediatric trauma.
BACKGROUND
There is a lack of information on the cost of treating trauma in children in developing countries. Therefore, in the pediatric emergency unit of a university hospital in Turkey, we prospectively investigated the cost factors of pediatric trauma and attempted to identify cost predictors.


METHODS
We prepared questionnaires and charts for 91 children (50 boys, 41 girls) admitted with multiple trauma to obtain data on age, gender, date and mechanism of injury, site of injury, type of the treatment and length of hospital stay. We studied the physical findings, Pediatric Trauma Score (PTS), Revised Trauma Score (RETS) and pediatric Glasgow Coma Scale (GCS) score, and we totalled all hospital-based costs according to Ministry of Health guidelines.


RESULTS
The mean (and standard deviation [SD]) age of the children was 79.4 (52.3) months. Motor vehicle crashes accounted for 45% of the injuries, followed by falls (41%) and bicycle accidents (14%). The mean (and SD) total cost of care was US dollar 376.60 (dollar 428.20) (range from dollar 20-dollar 1995). The cost associated with motor vehicle crashes was higher than that for the other injury types (p < 0.05). Seventeen patients required major and 27 patients required minor surgical treatment, whereas 44 patients were treated conservatively; 3 died. Forty-eight percent of patients were referred from another hospital, and the cost of care of referred patients was significantly higher than for those admitted directly (p < 0.001). The mean (and SD) duration of hospital stay was 98 (150) hours. Total cost correlated directly with the duration of hospital stay and distance of the referred hospital or accident scene from our hospital (p < 0.001, r = 0.827 and 0.374 respectively), but the cost correlated inversely with the PTS, the RETS and the pediatric GCS score (p < 0.001, r = -0.339, -0.301 and -0.453 respectively).


CONCLUSIONS
Our findings indicate that the cost of pediatric trauma is high and may be predicted from admission data and trauma scores.
Gürses
Dolunay
D
Department of Pediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey. dolunayk@yahoo.com
Sarioglu-Buke
Akile
A
Baskan
Merve
M
Kilic
Ilknur
I
D000058:Accidental Falls / Q000191:economics; D000063:Accidents, Traffic / Q000191:economics; D000293:Adolescent; D017677:Age Distribution; D001642:Bicycling / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D015600:Glasgow Coma Scale; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D009104:Multiple Trauma / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics; D015599:Trauma Severity Indices; D014421:Turkey / Q000453:epidemiology