Department of Neurology, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
J Neurotrauma. 2013 Jan 15;30(2):84-90. doi: 10.1089/neu.2011.2283.
Several new therapeutic strategies have been introduced for the management of adult traumatic brain injury (TBI) over the last decade, such as the development of management pathways and specialized TBI units and improved treatment of cerebral perfusion. The purpose of this study is to compare TBI-related hospitalization outcomes in the United States between two time periods, 1993-1994 and 2006-2007. We determined the rates of occurrence, in-hospital outcomes, and mean hospital charges for patients hospitalized with adult TBI in 1993-1994 using the nationally representative all-payer Nationwide Inpatient Survey (NIS) database, and compared these outcomes with homologous data from 2006-2007. The incidence of TBI admissions was reduced by 35% in 2006-2007 compared with 1993-1994; (22/100,000 versus 34/100,000 population; p<0.0001). The mean length of hospitalization (mean±SD, in days) was significantly lower in 2006-2007 than in 1993-1994 (2.5±2.4 days versus 2.7±2.6 days; p<0.0001). In-hospital mortality increased significantly in 2006-2007 compared with 1993-1994 (0.8% versus 0.4%, p<0.0001). Average hospitalization charges were significantly higher in 2006-2007 compared with 19993-1994 ($21,460±$21,212 versus $5,142±$4,625; p<0.0001), even after adjusting for inflation. In both time periods, most hospitalized adult TBI patients were graded as mild (98.2% in 1993-1994 versus 98.0% in 2006-2007; p=0.20). There was a significant increase in average hospitalization charges and death rates in all TBI severity subgroups in 2006-2007 compared with 1993-1994. The decline in rate of hospitalization between the two time periods was predominantly related to the decline in the number of admissions of patients with mild TBI. Although the number of TBI admissions was reduced, a significant increase in average hospitalization charges and in-hospital mortality rate was observed in 2006-2007 compared with 1993-1994.
过去十年中，针对成人创伤性脑损伤（TBI）的管理，已经引入了几种新的治疗策略，例如制定管理途径和专门的 TBI 单位以及改善脑灌注的治疗。本研究的目的是比较美国在两个时间段（1993-1994 年和 2006-2007 年）之间与 TBI 相关的住院治疗结果。我们使用全国代表性的所有付款人全国住院患者调查（NIS）数据库确定了 1993-1994 年成人 TBI 住院患者的发生率、住院结果和平均住院费用，并将这些结果与 2006-2007 年的同源数据进行了比较。与 1993-1994 年相比，2006-2007 年 TBI 入院率下降了 35%（每 100,000 人中有 22 人/100,000 人对 34 人/100,000 人；p<0.0001）。2006-2007 年的平均住院时间（平均值±SD，天数）明显短于 1993-1994 年（2.5±2.4 天对 2.7±2.6 天；p<0.0001）。与 1993-1994 年相比，2006-2007 年住院死亡率显著升高（0.8%对 0.4%；p<0.0001）。与 1993-1994 年相比，2006-2007 年的平均住院费用明显更高（$21,460±$21,212 对 $5,142±$4,625；p<0.0001），即使考虑到通货膨胀因素也是如此。在这两个时间段内，大多数住院成人 TBI 患者被评为轻度（1993-1994 年为 98.2%，2006-2007 年为 98.0%；p=0.20）。与 1993-1994 年相比，2006-2007 年所有 TBI 严重程度亚组的平均住院费用和死亡率均显著升高。与这两个时间段相比，住院率的下降主要与轻度 TBI 患者入院人数的减少有关。尽管 TBI 入院人数有所减少，但与 1993-1994 年相比，2006-2007 年的平均住院费用和住院死亡率显著增加。
