Rotondo Michael F, Bard Michael R, Sagraves Scott G, Toschlog Eric A, Schenarts Paul J, Goettler Claudia E, Newell Mark A, Robertson Matthew J
Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834,08, USA.
J Trauma. 2009 Nov;67(5):915-23. doi: 10.1097/TA.0b013e3181b848e7.
In 1999, a Level I Trauma Center committed significant resources for development, recruitment of trauma surgeons, and call pay for subspecialists. Although this approach has sparked a national ethical debate, little has been published investigating efficacy. This study examines the price of commitment and outcomes at a Level I Trauma Center.
Direct personnel costs including salary, call pay, and personnel expenses were analyzed against outcomes for two periods defined as PRE (1994-1999) and POST (2000-2005). Patient care costs and 1999 to 2000 transition data were excluded. Demographics, outcomes, and direct personnel costs were compared. Significant mortality reductions stratified by age and injury severity score (ISS) were used to calculate lives saved in relation to direct personnel costs. Student's t test and chi were used (significance *p < 0.05).
In the PRE period, there were 7,587 admissions compared with 11,057 POST. There were no significant differences PRE versus POST for age (41.4 +/- 24.4 years vs. 41.3 +/- 24.9 years), gender (62.4% vs. 63.7% male), mechanism of injury (11.5% vs. 11.8% penetrating), and percent intensive care unit admissions (30.1 vs. 29.9). Significant differences were noted for ISS (10.5 +/- 9.7 vs. 11.6 +/- 10.1*), percent admissions with ISS >or=16 (18.5 vs. 27.3*), and revised trauma score (10.8 +/- 2.8 vs. 10.7 +/- 2.8*). Both the average length of stay (6.8 +/- 8.8 vs. 6.5 +/- 9.8*) and percent mortality for ISS >or=16 (23 vs. 17*) were reduced. When mortality was stratified by both age and ISS, significant reductions were noted and a total of 173 lives were saved as a result. However, direct personnel costs increased from $7.6 million to $22.7 million. When cost is allocated to lives saved; the cost of a saved life was more than $87,000.
Resources for program development, including salary and call pay, significantly reduced mortality. Price of commitment: $3 million per year. The cost of a saved life: $87,000. The benefit: 173 surviving patients who would otherwise be dead.
1999年，一家一级创伤中心投入大量资源用于发展、招聘创伤外科医生以及支付专科医生的值班费。尽管这种做法引发了一场全国性的伦理辩论，但关于其效果的研究报道甚少。本研究探讨了一家一级创伤中心投入资源后的代价及结果。
分析了包括工资、值班费和人员费用在内的直接人员成本与两个时期（定义为PRE期[1994 - 1999年]和POST期[2000 - 2005年]）的结果之间的关系。排除了患者护理成本和1999年至2000年的过渡数据。比较了人口统计学、结果和直接人员成本。采用按年龄和损伤严重程度评分（ISS）分层的显著死亡率降低情况来计算与直接人员成本相关的挽救生命数。使用了学生t检验和卡方检验（显著性*p < 0.05）。
PRE期有7587例入院患者，POST期为11057例。PRE期与POST期在年龄（41.4 ± 24.4岁对41.3 ± 24.9岁）、性别（男性分别为62.4%对63.7%）、损伤机制（穿透伤分别为11.5%对11.8%）以及重症监护病房入院百分比（分别为30.1对29.9）方面无显著差异。在ISS（10.5 ± 9.7对11.6 ± 10.1*）、ISS≥16的入院百分比（18.5对27.3*）和修正创伤评分（10.8 ± 2.8对10.7 ± 2.8*）方面存在显著差异。平均住院时间（6.8 ± 8.8对6.5 ± 9.8*）和ISS≥16的死亡率百分比（23对17*）均有所降低。当按年龄和ISS对死亡率进行分层时，发现有显著降低，共挽救了173条生命。然而，直接人员成本从760万美元增加到了2270万美元。当将成本分摊到挽救的生命上时，挽救一条生命的成本超过87000美元。
用于项目发展的资源，包括工资和值班费，显著降低了死亡率。投入的代价：每年300万美元。挽救一条生命的成本：87000美元。益处：173名原本会死亡的患者存活了下来。
