title: Acute costs and predictors of higher treatment costs for major paediatric trauma in New South Wales, Australia.
abstract: OBJECTIVE
  To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres; to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia.
  
  
  METHODS
  Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries. Individual patient costs, Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs were obtained. Actual costs incurred by each hospital were compared with state-wide AR-DRG average costs. Multivariate multiple linear regression identified predictors of cost.
  
  
  RESULTS
  There were 3493 patients with a total cost of AUD$20.2 million. Falls (AUD$6.7 million) and road trauma (AUD$4.4 million) had the highest total expenditure. The reduction in cost between ISS < 9 compared to ISS 9-12 and ISS > 12 was significant (P < 0.0001). The median cost of injury increased with every additional body region injured (P < 0.0001). For each additional day spent in hospital, there was an increased cost of AUD$1898 and patients admitted to an intensive care unit (ICU) cost AUD$7358 more than patients not admitted to ICU. The total costs incurred by trauma centres were AUD$1.4 million above the NSW peer group average cost estimates.
  
  
  CONCLUSIONS
  The high financial cost of paediatric patient treatment highlights the need to ensure prevention remains a priority in Australia. Hospitals tasked with providing trauma care should be appropriately funded and future funding models should consider trauma severity.
authors.affiliation: Transport and Road Safety Research, University of New South Wales, Sydney, NSW 2052, Australia. r.mitchell@unsw.edu.au
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mitchell
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.forename: Andrew Ja
authors.initials: AJ
authors.lastname: Holland
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.forename: Julie
authors.initials: J
authors.lastname: Evans
authors.forename: Kellie L
authors.initials: KL
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009517:New South Wales; D014193:Trauma Centers / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics* / Q000401:mortality / Q000628:therapy
keywords: cost; health economics; health service; injury; paediatric; trauma