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Year : 2020  |  Volume : 18  |  Issue : 1  |  Page : 14-18

Retrospective study on cost accounting of trauma patients presenting to the Emergency Department in a tertiary care hospital in South India

1 Department of Emergency Medicine, Pacific International Hospital, Papua New Guinea
2 Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Didla Gautam
Department of Emergency, Pacific International Hospital, Port Moresby
Papua New Guinea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_62_19

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Background: Accelerated urbanization and industrialization have led to an alarming increase in the rates of trauma that eventually increases the financial burden of society. Understanding the direct medical costs associated with trauma provides a window for assessing the potential cost reductions with improved quality care in the Emergency department (ED). Aim: The aim is to analyze the possibilities of minimizing the expenditure of trauma patients presenting to priority I and priority II of the emergency department (ED), without compromising care and treatment. Materials and Methods: This is a retrospective study done in the ED of CMC Vellore in the month of January 2017. Multiple regression was used to categorize patients into major or minor trauma on the basis of Glasgow Coma Scale, hemodynamic stability, unstable abdominal/pelvic fractures, chest trauma (subcutaneous emphysema/open pneumothorax/penetrating chest injury), hypovolemic shock, and polytrauma. The costs of each type of trauma were then calculated after adjusting for differences in age, gender, mode of injury, influence of alcohol, and system(s) involvement. Results: A total of 119 trauma patients who were admitted in priority I and II were studied in a period of 1 month, among which majority were male 97 (81.5%) patients. It was noted that the incidence of trauma was the highest in the adult age group, i.e., 91 (76.5%) patients. Road traffic accident was the most common mode of injury and seen in 83 (69.7%) patients. In injury profile, lower limb injuries were most commonly involved and contributed to 37 (31.1%) patients, followed by upper limb injuries in 21 (17.6%) patients and isolated head injuries in 15 (12.6%) patients. The average cost was more in patients suffering from major trauma (Rs. 10,983/-) in comparison to minor trauma (Rs. 6464/-), with the maximum expenditure in radiological investigation. In about 18 (15%) patients, blood tests and imaging were done without proper indication which led to additional expenditure. Among all these trauma patients, 40.3% of patients needed admission either in ICU or ward and underwent major surgical procedures, 44.5% of patients were discharged in a stable condition, 13.5% of patients were either discharged against medical advice or discharged at request after primary care and 1.7% of the patients died during their stay (primary Resuscitation) in the ED. Conclusions: This study shows the cost-benefit analysis in major trauma while maintaining high quality care and treatment.

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