title: Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury.
abstract: Adherence to pediatric traumatic brain injury guidelines has been associated with improved survival and better functional outcome. However, the relationship between guideline adherence and hospitalization costs has not been examined. To evaluate the relationship between adherence to pediatric severe traumatic brain injury guidelines, measured by acute care clinical indicators, and the total costs of hospitalization associated with severe traumatic brain injury.
  
  
  
  Retrospective cohort study.
  
  
  
  Five regional pediatric trauma centers affiliated with academic medical centers.
  
  
  
  Demographic, injury, treatment, and charge data were included for pediatric patients (17 yr) with severe traumatic brain injury.
  
  
  
  Percent adherence to clinical indicators was determined for each patient. Cost-to-charge ratios were used to estimate ICU and total hospital costs for each patient. Generalized linear models evaluated the association between healthcare costs and adherence rate.
  
  
  
  Cost data for 235 patients were examined. Estimated mean adjusted hospital costs were $103,485 (95% CI, 98,553-108,416); adjusted ICU costs were $82,071 (95% CI, 78,559-85,582). No association was found between adherence to guidelines and total hospital or ICU costs, after adjusting for patient and injury characteristics. Adjusted regression model results provided cost ratio equal to 1.01 for hospital and ICU costs (95% CI, 0.99-1.03 and 0.99-1.02, respectively).
  
  
  
  Adherence to severe pediatric traumatic brain injury guidelines at these five leading pediatric trauma centers was not associated with increased hospitalization and ICU costs. Therefore, cost should not be a factor as institutions and providers strive to provide evidence-based guideline driven care of children with severe traumatic brain injury.
authors.affiliation: 1College of Nursing-Spokane, Washington State University, Spokane, WA. 2Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. 3Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 4Department of Pediatrics, Harbor-UCLA and Los Angeles BioMedical Research Institute, Torrance, CA. 5Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. 6Department of Surgery, the Ohio State University College of Medicine, Columbus, OH. 7Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 8Division of Pediatric Neurology, Department of Neurosurgery, Mattel Children's Hospital, UCLA, Los Angeles, CA. 9Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. 10Department of Neurological Surgery, University of Washington, Seattle, WA. 11Department of Global Health Medicine, University of Washington, Seattle, WA. 12Department of Industrial and Systems Engineering, University of Washington, Seattle, WA. 13Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA. 14Department of Epidemiology, University of Washington, Seattle, WA. 15Departments of Pediatrics, University of Washington, Seattle, WA.
authors.forename: Janessa M
authors.initials: JM
authors.lastname: Graves
authors.forename: Nithya
authors.initials: N
authors.lastname: Kannan
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mink
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Linda Ng
authors.initials: LN
authors.lastname: Boyle
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States