title: Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.
abstract: BACKGROUND
  The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma.
  
  
  METHODS
  In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods.
  
  
  RESULTS
  There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs.
  
  
  CONCLUSIONS
  In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied considerably. As long term morbidity is common in this population, a history of resolved neurologic deficit may require greater intervention to mitigate costs. Additionally, adequate communication between acute and community care providers is essential in order to expedite the recovery process through early return to normal daily activities.
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. h.ackland@alfred.org.au
authors.forename: Helen M
authors.initials: HM
authors.lastname: Ackland
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Varma
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fitt
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
authors.forename: Susan M
authors.initials: SM
authors.lastname: Liew
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001334:Automobile Driving; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D006233:Persons with Disabilities; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007103:Immobilization / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000191:economics* / Q000503:physiopathology; D010146:Pain / Q000000981:diagnostic imaging / Q000191:economics* / Q000503:physiopathology; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000191:economics* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000191:economics; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000191:economics* / Q000503:physiopathology