title: Assessment of medical resource utilization for Taiwanese children hospitalized for intracranial injuries.
abstract: BACKGROUND
  Compared to adults, children and adolescents are at greater risk for traumatic brain injury (TBI), with increased severity and prolonged recovery when compared to adults. It is a challenge to provide care for those children who are at risk for complications of TBI under health care resource constraints.
  
  
  OBJECTIVE
  To investigate hospitalization among children with intracranial injuries in terms of incidence and factors related to length of stay (LOS) and medical cost.
  
  
  METHODS
  Data from the National Health Insurance Research Database from 2007-2009 were used. In total 8632 children aged <=18 years with acute traumatic intracranial injuries caused by accidents were discharged from hospitals in Taiwan. The associations between patient and hospital covariates (e.g., age, gender, accreditation level of hospital, surgical intervention, and number of comorbid conditions) and log-transferred hospitalization cost and length of stay (LOS) were examined with multivariable regression analysis and mediation analyses.
  
  
  RESULTS
  The incidence rate of hospitalization for acute intracranial injury was 63.3/100,000 per year. Motor vehicle crashes and falls accounted for 63.5% and 23.8% of intracranial injuries, respectively. The mean LOS for children was 5.0 days (median, 3 days), incurring a mean direct medical cost of $US 916.70 (median, $356.2). Boy sustained more injury (64.1%) and greater medicals cost ($965) occurred in boys. Patients with subarachnoid subdural and extradural haemorrhage tended to have a longer LOS and incur greater medical costs. Surgical intervention and type of healthcare institution were also significant predictors for medical costs. Additionally, LOS was the dominant mediator for the relationship between predictor and medical cost.
  
  
  CONCLUSIONS
  Acute intracranial injuries among children incur a substantial health care burden. Therefore, health authorities need to optimally allocate medical resources in care.
authors.affiliation: Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan. Electronic address: cmlin@mail.mcu.edu.tw.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000191:economics / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D006259:Craniocerebral Trauma / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007348:Insurance, Health; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D011050:Policy Making; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Children; Intracranial injury; Length of stay; Mediator; Medical resource utilization; Traumatic brain injury