Evaluating true cost of pediatric traumatic brain injury by analyzing total charges across multiple clinical settings

Background: Although many traumatic brain injuries (TBIs) present to emergency departments (EDs), data limited to EDs severely underestimate the cost of TBI. The objective was to estimate the true cost of pediatric TBIs across multiple clinical settings in one large, pediatric hospital.

Methods: All TBIs sustained by children ≤20 years treated at one large Midwest Children's Hospital from August 1, 2010 through July 31, 2011 were identified using ICD-9 codes 310.2, 800-801.9, 803-804.9, 850-854.16, and 959.01. Results: 3,971 individuals ≤20 years were seen during 5,429 TBI-related visits. Total charges for all pediatric TBI-related visits were $13,131,546.85 with an average total charge per patient of $3,306.86 (SD: $26,225.49). The highest proportion of total charges was associated with inpatient visits (31.5%); however, 16.9% was associated with clinic outpatient visits. While mild TBIs (mTBIs) accounted for 92.0% of all TBI-related visits, they accounted for 44.7% of all TBI-related charges. mTBIs treated in the emergency department had a higher average total charge (mean: $1,185.46; SD: $1,796.92) than mTBIs treated in urgent care (mean: $264.72; SD: $217.88) (p<0.0001).

Conclusions: This study, the first to evaluate the true cost burden of pediatric traumatic brain injuries by analyzing total charges across multiple clinical settings at one large Midwest Children's Hospital, found that previous research utilizing only inpatient or ED data has severely underestimated the cost of pediatric TBIs. Investigating TBIs across the full spectrum of clinical care is needed for a better understanding of the true clinical cost and public health burden of pediatric TBI.