创伤后急性呼吸窘迫综合征治疗的医疗保健利用和费用。
Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care.
机构信息
From the Department of Surgery (A.J.R., L.Z.K., B.M.H., A.S.C., R.A.C.), Department of Medicine (C.M.H., F.M., C.S.C.), San Francisco General Hospital and the University of California, San Francisco, San Francisco, California; and Department of Surgery (M.J.C.), Denver Health Medical Center and the University of Colorado, Denver, Colorado.
出版信息
J Trauma Acute Care Surg. 2018 Jul;85(1):148-154. doi: 10.1097/TA.0000000000001926.
BACKGROUND
Posttraumatic acute respiratory distress syndrome (ARDS) is associated with prolonged mechanical ventilation and longer hospitalizations. The relationship between posttraumatic ARDS severity and financial burden has not been previously studied. We hypothesized that increasing ARDS severity is associated with incrementally higher health care costs.
METHODS
Adults arriving as the highest level of trauma activation were enrolled in an ongoing prospective cohort study. Patients who survived 6 hours or longer are included in the analysis. Blinded review of chest radiographs was performed by two independent physicians for any intubated patient with PaO2:FIO2 ratio of 300 mmHg or lower during the first 8 days of admission. The severity of ARDS was classified by the Berlin criteria. Hospital charge data were used to perform standard costing analysis.
RESULTS
Acute respiratory distress syndrome occurred in 13% (203 of 1,586). The distribution of disease severity was 33% mild, 42% moderate, and 25% severe. Patients with ARDS were older (41 years vs. 35 years, p < 0.01), had higher median Injury Severity Score (30 vs. 10, p < 0.01), more chest injury (Abbreviated Injury Scale score, ≥ 3: 51% vs. 21%, p < 0.01), and blunt mechanisms (85% vs. 53%, p < 0.01). By ARDS severity, there was no significant difference in age, mechanism, or rate of traumatic brain injury. Increasing ARDS severity was associated with higher Injury Severity Score and higher mortality rates. Standardized total hospital charges were fourfold higher for patients who developed ARDS compared with those who did not develop ARDS (US $434,000 vs. US $96,000; p < 0.01). Furthermore, the daily hospital charges significantly increased across categories of worsening ARDS severity (mild, US $20,451; moderate, US $23,994; severe, US $33,316; p < 0.01).
CONCLUSION
The development of posttraumatic ARDS is associated with higher health care costs. Among trauma patients who develop ARDS, total hospital charges per day increase with worsening severity of disease. Prevention, early recognition, and treatment of ARDS after trauma are potentially important objectives for efforts to control health care costs in this population.
LEVEL OF EVIDENCE
Economic and value-based evaluations, level IV.
背景
创伤后急性呼吸窘迫综合征（ARDS）与长时间机械通气和住院时间延长有关。创伤后 ARDS 严重程度与经济负担之间的关系尚未得到研究。我们假设 ARDS 严重程度的增加与医疗费用的增加有关。
方法
到达最高级别创伤激活的成年人被纳入一项正在进行的前瞻性队列研究。在入住的前 8 天内，任何接受机械通气且 PaO2：FIO2 比值低于 300mmHg 的患者，如果进行了胸部 X 光检查，都将由两名独立的医生进行盲法审查。根据柏林标准对 ARDS 的严重程度进行分类。使用医院收费数据进行标准成本分析。
结果
急性呼吸窘迫综合征的发生率为 13%（203/1586）。疾病严重程度的分布为 33%轻度、42%中度和 25%重度。ARDS 患者年龄更大（41 岁比 35 岁，p<0.01），中位损伤严重度评分更高（30 分比 10 分，p<0.01），胸部损伤更多（损伤严重度评分≥3 分：51%比 21%，p<0.01），且钝性机制更常见（85%比 53%，p<0.01）。根据 ARDS 的严重程度，在年龄、机制或创伤性脑损伤的发生率方面没有显著差异。ARDS 严重程度的增加与更高的损伤严重度评分和更高的死亡率相关。与未发生 ARDS 的患者相比，发生 ARDS 的患者的标准化总住院费用高出四倍（US$434,000 比 US$96,000；p<0.01）。此外，随着 ARDS 严重程度的恶化，每日住院费用显著增加（轻度，US$20,451；中度，US$23,994；重度，US$33,316；p<0.01）。
结论
创伤后 ARDS 的发生与更高的医疗费用有关。在发生 ARDS 的创伤患者中，随着疾病严重程度的恶化，每日总住院费用增加。预防、早期识别和治疗创伤后 ARDS 可能是控制该人群医疗费用的重要目标。
证据水平
经济和基于价值的评估，IV 级。
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