RT Journal Article
SR Electronic
T1 Intensity of hospital resource use following traumatic brain injury: a multicentre cohort study, 2013–2016
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP E143
OP E153
DO 10.1503/cjs.007819
VO 65
IS 2
A1 Assy, Coralie
A1 Moore, Lynne
A1 Porgo, Teegwendé Valérie
A1 Farhat, Imen
A1 Tardif, Pier-Alexandre
A1 Truchon, Catherine
A1 Stelfox, Henry T.
A1 Gabbe, Belinda J.
A1 Lauzier, François
A1 Turgeon, Alexis F.
A1 Clément, Julien
YR 2022
UL https://www.canjsurg.ca/content/65/2/E143.abstract
AB Background: The knowledge gap regarding acute care resource use for patients with traumatic brain injury (TBI) impedes efforts to improve the efficiency and quality of the care of these patients. Our objective was to evaluate interhospital variation in resource use for patients with TBI, identify determinants of high resource use and assess the association between hospital resource use and clinical outcomes.Methods: We conducted a multicentre retrospective cohort study including patients aged 16 years and older admitted to the inclusive trauma system of Quebec following TBI, between 2013 and 2016. We estimated resource use using activity-based costs. Clinical outcomes included mortality, complications and unplanned hospital readmission. Interhospital variation was evaluated using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs). Correlations between hospital resource use and clinical outcomes were evaluated using correlation coefficients on weighted, risk-adjusted estimates with 95% CIs.Results: We included 6319 patients. We observed significant interhospital variation in resource use for patients discharged alive, which was not explained by patient case mix (ICC 0.052, 95% CI 0.043 to 0.061). Adjusted mean resource use for patients discharged to long-term care was more than twice that of patients discharged home. Hospitals with higher resource use tended to have a lower incidence of mortality (r −0.347, 95% CI −0.559 to −0.087) and unplanned readmission (r −0.249, 95% CI −0.481 to 0.020) but a higher incidence of complications (r 0.491, 95% CI 0.255 to 0.666).Conclusion: Resource use for TBI varies significantly among hospitals and may be associated with differences in mortality and morbidity. Negative associations with mortality and positive associations with complications should be interpreted with caution but suggest there may be a trade-off between adverse events and survival that should be evaluated further.