title: Direct medical charges of pediatric traumatic brain injury in multiple clinical settings.
abstract: BACKGROUND
  Data limited to emergency department and inpatient visits undoubtedly underestimate the medical charges associated with traumatic brain injury. The objective of this study was to estimate the direct medical charges of pediatric traumatic brain injuries across all clinical settings in one large, pediatric hospital in the United States.
  
  
  METHODS
  Traumatic brain injuries sustained by children ≤20 years of age treated across all clinical settings at one large pediatric hospital from August 1, 2010-July 31, 2011 were identified using ICD-9-CM codes 310.2, 800-801.9, 803-804.9, 850-854.16, and 959.01.
  
  
  RESULTS
  3,971 individuals ≤20 years of age were seen during 5,429 traumatic brain injury-related visits. Total medical charges for pediatric traumatic brain injury-related visits were $13,131,547. Inpatient (68.7%) and emergency department (16.1%) visits accounted for the highest proportion of TBI-related charges; however, >15% of all charges were associated with visits to clinic outpatient, urgent care, and diagnostic/therapy outpatient settings. Fracture of the vault or base of the skull (37.1%) and brain injury with contusion, laceration, or hemorrhage (27.1%) accounted for the largest proportion of total charges. Although unspecified head injuries made up almost half of all TBI-related visits (47.4%), they accounted for only 12.6% of total charges. Mild traumatic brain injuries accounted for 92.0% of all traumatic brain injury-related visits but only 44.7% of all traumatic brain injury-related charges. Mild traumatic brain injuries treated in the emergency department had a higher median total charge than those treated in urgent care (p < 0.0001) or clinic outpatient setting (p < 0.001).
  
  
  CONCLUSIONS
  This study, the first to evaluate the direct medical charges of pediatric traumatic brain injury across all clinical settings at one large pediatric hospital, found that pediatric traumatic brain injuries present to a wide variety of clinical settings, and differences exist in total charges by diagnosis, severity of the injury, and clinical site/setting. Investigating traumatic brain injuries across the full spectrum of clinical care is needed for a better understanding of the true medical cost and public health burden of pediatric traumatic brain injury.
authors.affiliation: Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Christy L
authors.initials: CL
authors.lastname: Collins
authors.affiliation: Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.|Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
authors.affiliation: Department of Pediatrics and Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.|Division of Sports Medicine Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Pommering
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Andridge
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Coronado
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Gilchrist
authors.affiliation: Colorado School of Public Health, Epidemiology and Pediatric Injury Prevention, Education, and Research (PIPER) Program, Aurora, CO, USA. dawn.comstock@ucdenver.edu.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
keywords: Children; Medical charges; Traumatic brain injury