title: The financial outcome of traumatic brain injury: a single centre study.
abstract: OBJECTIVE
  Severe traumatic brain injury (TBI) is a potentially devastating insult to the brain with high rates of fatality and neurological deficits. TBI can result in substantial costs to the centre providing care. We sought to present the experience of a Major Trauma Centre (MTC) and ascertain the financial implications of this healthcare provision, in particular detailed costs, reimbursement and the surplus or deficit accrued by the centre.
  
  
  METHODS
  All cranial non-elective neurosurgical admissions with a TBI over 4.5 months (26 October 2014 to 15 March 2015) were analysed retrospectively, excluding cases of chronic subdural haematoma, at an MTC in England. Demographic data were collected alongside detailed cost and income data.
  
  
  RESULTS
  Ninety four patients were identified. The majority of patients presented with more than one diagnosis of cranial trauma. Average length of stay was 18.8 ± 21.6 days. Total deficits as a result of treating this cohort amounted to £558,034. There was a significant association between (i) more complex presentations and (ii) a longer length of stay and the deficit accrued by the centre. The major drivers of the financial outcome were costs associated with wards, medical staffing and overheads.
  
  
  CONCLUSIONS
  There was a substantial deficit accrued as a result of the management of patients with TBI at an MTC. The more complex the presentation, extensive the intervention, and lengthy the stay, the greater the deficit accrued by the centre. The current tariff payment system is not effectively reflecting the severity of injury or intensity of management of patients with TBI.
authors: a Division of Neurosurgery , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK.
authors: Daniel M
authors: http://orcid.org/0000-0001-6227-9930
authors: DM
authors: Fountain
authors: a Division of Neurosurgery , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK.
authors: Angelos G
authors: http://orcid.org/0000-0003-3992-0587
authors: AG
authors: Kolias
authors: a Division of Neurosurgery , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK.
authors: Rodney J
authors: RJ
authors: Laing
authors: a Division of Neurosurgery , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK.
authors: Peter J
authors: PJ
authors: Hutchinson
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000191:economics* / Q000601:surgery; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004739:England; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*
keywords: Traumatic brain injury; cost-analysis; costs; service improvement; tariffs