Obertacke U, Neudeck F, Wihs H J, Schmit-Neuerburg K P
Abteilung für Unfallchirurgie, Universitätsklinikum Essen.
Langenbecks Arch Chir Suppl Kongressbd. 1996;113:641-5.
Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days on ICU, the total costs were DM 106924.36 (about 70,000 US $). DM 39,635.88 (= 37%) were the costs for physicians and nurses; DM 67,289.08 (= 63%) were needed for materials, X-rays, laboratory investigations, drugs and blood components. The whole treatment caused daily costs of DM 4752.22 or DM 3.30/min. The first emergency diagnostic procedures and emergency therapy take a mean time of 451.9 min from admission to the beginning of the ICU treatment and by itself already generates costs of about DM 12325.99. In Germany, a new way of compensation by a diagnosis-related group was introduced in 1996. These data suggest that treatment of severe multiple trauma is very expensive and trauma care could be economically harmful for smaller hospitals. We conclude that treatment of multiply injured patients (ISS > 16 p) should be compensated for by a special daily amount of about DM 5000 (about 3500 US $) for selected trauma centres.
对20例随机选取的、具有代表性的严重多发伤患者（平均损伤严重度评分32分）的急诊治疗、手术及重症监护的费用进行了分析。患者在重症监护病房平均住院约22.5天，总费用为106924.36德国马克（约70,000美元）。其中，医师和护士费用为39,635.88德国马克（占37%）；材料、X光、实验室检查、药品及血液成分费用为67,289.08德国马克（占63%）。整个治疗过程每天费用为4752.22德国马克或每分钟3.30德国马克。从入院到开始重症监护治疗，首次急诊诊断程序和急诊治疗平均耗时451.9分钟，其本身就已产生约12325.99德国马克的费用。1996年，德国引入了一种基于诊断相关组的新补偿方式。这些数据表明，严重多发伤的治疗费用非常高昂，对于较小的医院而言，创伤护理在经济上可能是有害的。我们得出结论，对于选定的创伤中心，应按每天约5000德国马克（约3500美元）的特殊金额对多发伤患者（损伤严重度评分>16分）的治疗进行补偿。
