Wiegand Jared G, Moazzam Zorays, Braga Bruno P, Messiah Sarah E, Qureshi Faisal G
School of Public Health, University of Texas Health Science Center, Dallas, TX, United States.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Front Neurol. 2024 Nov 29;15:1385100. doi: 10.3389/fneur.2024.1385100. eCollection 2024.
Traumatic brain injury (TBI) is a leading cause of death and disability in children, but data on the longitudinal healthcare and financial needs of pediatric patients is limited in scope and duration. We sought to describe and predict these metrics following acute inpatient treatment for TBI.
Children surviving their initial inpatient treatment for TBI were identified from Optum's deidentified Clinformatics® Data Mart Database (2007-2018). Treatment cost, healthcare utilization, and future inpatient readmission were stratified by follow-up intervals, type of claim, and injury severity. Both TBI-related and non-TBI related future cost and healthcare utilization were explored using linear mixed models. Acute inpatient healthcare utilization metrics were analyzed and used to predict future treatment cost and healthcare demands using linear regression models.
Among 7,400 patients, the majority suffered a mild TBI (50.2%). For patients with at least one-year follow-up (67.7%), patients accrued an average of 28.7 claims and $27,199 in costs, with 693 (13.8%) readmitted for TBI or non-TBI related causes. Severe TBI patients had a greater likelihood of readmission. Initial hospitalization length of stay and discharge disposition other than home were significant positive predictors of healthcare and financial utilization at one-and five-years follow-up. Linear mixed models demonstrated that pediatric TBI patients would accrue 21.1 claims and $25,203 in cost in the first year, and 9.4 claims and $4,147 in costs every additional year, with no significant differences based on initial injury severity.
Pediatric TBI patients require long-term healthcare and financial resources regardless of injury severity. Our cumulative findings provide essential information to clinicians, caretakers, researchers, advocates, and policymakers to better shape standards, expectations, and management of care following TBI.
创伤性脑损伤（TBI）是儿童死亡和残疾的主要原因，但关于儿科患者纵向医疗保健和经济需求的数据在范围和持续时间上有限。我们试图描述和预测TBI急性住院治疗后的这些指标。
从Optum的去识别化临床信息学数据集市数据库（2007 - 2018年）中识别出在TBI初次住院治疗后存活的儿童。治疗成本、医疗保健利用率和未来住院再入院情况按随访间隔、索赔类型和损伤严重程度进行分层。使用线性混合模型探讨了与TBI相关和与非TBI相关的未来成本及医疗保健利用率。分析急性住院医疗保健利用率指标，并使用线性回归模型预测未来治疗成本和医疗需求。
在7400名患者中，大多数患有轻度TBI（50.2%）。对于至少有一年随访的患者（67.7%），患者平均有28.7次索赔，成本为27199美元，其中693人（13.8%）因TBI或非TBI相关原因再次入院。重度TBI患者再次入院的可能性更大。初次住院的住院时间和除回家以外的出院处置是1年和5年随访时医疗保健和经济利用的显著正预测因素。线性混合模型表明，儿科TBI患者在第一年将有21.1次索赔，成本为25203美元，此后每年额外有9.4次索赔，成本为4147美元，且根据初始损伤严重程度无显著差异。
无论损伤严重程度如何，儿科TBI患者都需要长期的医疗保健和财政资源。我们的累积研究结果为临床医生、护理人员、研究人员、倡导者和政策制定者提供了重要信息，以更好地制定TBI后护理的标准、期望和管理方案。
