Pressley Joyce C, Trieu Lisa, Kendig Tiffany, Barlow Barbara
Department of Epidemiology, Columbia University, New York, NY 10032, USA.
J Trauma. 2007 Sep;63(3 Suppl):S10-9. doi: 10.1097/TA.0b013e31812f5ea7.
Examination of expenditures in areas where more universal application of effective injury prevention approaches is indicated could identify specific mechanisms and age groups where effective intervention may impact public injury-related expenditures.
The Healthcare Cost and Utilization Project 2003 (KID-HCUP) contains acute care hospitalization data for U.S. children and adolescents residing in 36 states. The study population includes 240,248 unweighted (397,943 weighted) injury-related hospital discharges for ages 0 to 19 years. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores (ICISS). SUDAAN was employed to adjust variances for stratified sampling. Expenditures were weighted to represent the U.S. population.
Injury-related hospitalizations (mean $28,137 +/- 64,420, median $10,808) were more costly than non-injury discharges, accounting for approximately 10% of all persons hospitalized (unweighted), but more than one-fifth of expenditures. Public sources were the primary payor for 37.7% of injured persons. Incidence and cost per case variations across specific injury mechanisms heavily influenced total mechanism specific expenditures. Motor vehicle crashes were the largest expenditures for private and public payors with two thirds of expenditures in teenagers - more than 40% for drivers. Medicaid covered 45.6% ($192 million) of burn expenditures and 59.2% in 0-4 year olds. Expenditures per case (mean +/- SD, median) were: firearm ($36,196 +/- 58,052, $19,020), motor vehicle driver ($33,731 +/- 50,583, $18,431), pedestrian ($31,414 +/- 57,103, $16,552); burns ($29,242 +/- 64,271, $10,739); falls ($13,069 +/- 20,225, $8,610); and poisoning ($8,290 +/- $15,462, $5,208).
More universal application of proven injury prevention has the potential to decrease both the public and private health expenditure burden among several modifiable injury mechanisms.
对那些表明需要更广泛应用有效伤害预防方法的领域进行支出审查，可能会确定有效的干预措施可能影响公共伤害相关支出的具体机制和年龄组。
2003年医疗保健成本与利用项目（儿童医疗保健成本与利用项目）包含了居住在36个州的美国儿童和青少年的急性护理住院数据。研究人群包括240,248例（加权后为397,943例）0至19岁与伤害相关的医院出院病例。使用ICDMAP - 90和国际伤害严重程度评分（ICISS）评估伤害严重程度。采用SUDAAN对分层抽样的方差进行调整。支出进行加权以代表美国人口。
与伤害相关的住院治疗（平均费用28,137美元±64,420美元，中位数10,808美元）比非伤害性出院费用更高，占所有住院患者的约10%（未加权），但占支出的五分之一以上。公共来源是37.7%受伤者的主要支付方。特定伤害机制的发病率和每例费用差异对特定机制的总支出有重大影响。机动车碰撞事故是私人和公共支付方支出最大的项目，青少年的支出占三分之二，其中司机的支出超过40%。医疗补助涵盖了45.6%（1.92亿美元）的烧伤支出，在0至4岁儿童中这一比例为59.2%。每例支出（平均±标准差，中位数）分别为：火器伤（36,196美元±58,052美元，19,020美元）、机动车驾驶员伤害（33,731美元±50,583美元，18,431美元）、行人伤害（31,414美元±57,103美元，16,552美元）；烧伤（29,242美元±64,271美元，10,739美元）；跌倒（13,069美元±20,225美元，8,610美元）；中毒（8,290美元±15,462美元，5,208美元）。
更广泛地应用已证实的伤害预防措施有可能减轻几种可改变的伤害机制给公共和私人卫生支出带来的负担。
