London Jason A, Utter Garth H, Battistella Felix, Wisner David
Department of Surgery, Division of Trauma and Emergency Surgery, University of California, Davis, Sacramento, California 95817, USA.
J Trauma. 2009 Feb;66(2):485-90. doi: 10.1097/TA.0b013e318160e1db.
The clinical effects of methamphetamines (MA) may complicate medical management, potentially increasing resource utilization and hospital costs out of proportion to the patient's severity of injury. We hypothesize that minimally injured (MI) patients testing positive for MA consume more resources than patients testing negative for MA.
Adult trauma patients were identified from 4 years of registry data, which was linked to cost data from our center's financial department. Patients were classified as MI (Injury Severity Score <9) or severely injured (Injury Severity Score >9). Primary outcome was total direct costs for the inpatient hospital stay. Secondary outcomes included direct costs by cost center, contribution margin, and hospital length of stay.
Sixty-five percent (n = 6,193) of the 10,663 adult patients during the study period were admitted with MI. Nine percent (n = 557) of those tested were positive for MA. Total direct costs were higher in MI MA patients compared to nonusers ($2,998 vs. $2,667, p < 0.001), and users consumed more resources in all 10 cost centers. The same multivariate model showed marginally increased costs with MI alcohol users, but not with MI cocaine users or severely injured MA users.
MI MA patients consume more resources than patients testing negative for MA. Although MA use complicates the initial evaluation of patients, resource consumption was increased for all cost centers representing the entirety of a patients hospital stay, suggesting that the influence of MA is not limited to the initial diagnostic workup. Centers with high proportions of MA users may realize significant losses if compensation contracts are inadequate.
甲基苯丙胺（MA）的临床影响可能会使医疗管理复杂化，可能会导致资源利用增加，医院成本增加，且与患者的损伤严重程度不成比例。我们假设，MA检测呈阳性的轻伤（MI）患者比MA检测呈阴性的患者消耗更多资源。
从4年的登记数据中识别成年创伤患者，这些数据与我们中心财务部门的成本数据相关联。患者被分类为轻伤（损伤严重度评分<9）或重伤（损伤严重度评分>9）。主要结局是住院期间的总直接成本。次要结局包括各成本中心的直接成本、边际贡献和住院时间。
在研究期间的10663例成年患者中，65%（n = 6193）为轻伤入院。检测者中有9%（n = 557）MA呈阳性。与未使用MA的患者相比，MI MA患者的总直接成本更高（2998美元对2667美元，p < 0.001），且使用者在所有10个成本中心消耗的资源更多。同一多变量模型显示，MI酒精使用者的成本略有增加，但MI可卡因使用者或重伤MA使用者则没有。
MI MA患者比MA检测呈阴性的患者消耗更多资源。虽然使用MA会使患者的初始评估复杂化，但代表患者整个住院期间的所有成本中心的资源消耗都增加了，这表明MA的影响不仅限于初始诊断检查。如果补偿合同不充分，MA使用者比例高的中心可能会遭受重大损失。
